Injury-International Journal of the Care of the Injured最新文献

{"title":"Prehospital spinal immobilization and motion restriction strategies: A scoping review of the literature","authors":"Federico Cucci ,&nbsp;Dario Marasciulo ,&nbsp;Roberto Lupo ,&nbsp;Luana Conte ,&nbsp;Giovanni Soldano ,&nbsp;Cosimo Caldararo ,&nbsp;Leonardo Zizzi ,&nbsp;Emanuele Lagazzi ,&nbsp;Michele Bonetti","doi":"10.1016/j.injury.2026.113024","DOIUrl":"10.1016/j.injury.2026.113024","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital management of suspected spinal injury has long relied on routine full immobilization. In recent years, several studies have questioned its benefit and highlighted possible adverse effects. The aim of this scoping review is to describe the evidence on the management of patients with suspected spinal injury, focusing on models based on full immobilization with rigid devices and a cervical collar, and on strategies of selective spinal motion restriction (SMR).</div></div><div><h3>Methods</h3><div>A scoping review was conducted according to JBI methodology and PRISMA-ScR guidance, with a protocol registered on the Open Science Framework. The literature search was carried out in the PubMed, Scopus and Web of Science databases. Studies on adults or children with suspected traumatic spinal injury managed in the out-of-hospital setting were included when strategies of full immobilization, selective SMR or no immobilization were described or compared.</div></div><div><h3>Results</h3><div>Twenty-seven studies met the inclusion criteria, including observational cohorts, experimental studies on volunteers, simulation studies and qualitative research. Overall, no clear advantage of routine full immobilization over more selective strategies emerges. Selective SMR based on clinical assessment and decision rules appears to reduce the use of rigid devices without evidence of increased missed unstable injuries. Prolonged immobilization is instead associated with pain, discomfort, alterations in tissue perfusion and greater use of imaging examinations. The overall body of evidence is heterogeneous and largely based on observational studies, in which the influence of confounding factors cannot be fully ruled out.</div></div><div><h3>Conclusions</h3><div>The available evidence supports moving away from routine full immobilization towards selective SMR in the prehospital setting. Emergency medical services should update protocols and training accordingly and promote prospective studies focused on clinical outcomes and patient experience.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113024"},"PeriodicalIF":2.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981573","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}

{"title":"Wiring fixation for acetabular column fractures: Mid-term outcomes and survival according to reduction quality and fracture pattern","authors":"Chan Young Lee,&nbsp;Taek-Rim Yoon,&nbsp;Kyung-Soon Park","doi":"10.1016/j.injury.2026.113016","DOIUrl":"10.1016/j.injury.2026.113016","url":null,"abstract":"<div><h3>Background</h3><div>Acetabular column fractures remain among the most complex injuries in orthopedic trauma. Conventional plating techniques require extensive soft-tissue dissection and are associated with high complication rates. The wiring technique, which achieves compression across both acetabular columns through the greater and lesser sciatic notches, was developed to minimize surgical morbidity. This study aimed to evaluate the mid-term clinical and radiologic outcomes of this technique and to analyze factors affecting hip joint preservation.</div></div><div><h3>Methods</h3><div>This retrospective study included 41 patients who underwent fixation of acetabular column fractures using the wiring technique between 1994 and 2018 at a single tertiary referral center. A dual approach combining the Kocher–Langenbeck and mini-iliofemoral incisions was used. Clinical outcomes were evaluated using the Harris Hip Score (HHS) and Visual Analog Scale (VAS), and radiologic reduction was graded according to Matta’s criteria. Survivorship was analyzed using Kaplan–Meier methods with conversion to total hip arthroplasty (THA) as the endpoint.</div></div><div><h3>Results</h3><div>The cohort included 29 men and 12 women, with a mean age of 51.2 years and a mean follow-up duration of 11.4 years. The mean operation time was 139.8 minutes. Intraoperative complications included one case each of superior gluteal artery injury, sciatic nerve palsy, and lateral femoral cutaneous nerve injury. Postoperative complications were rare. Anatomical or near-anatomical reduction was achieved in 97.5% of patients. The mean HHS and VAS at final follow-up showed satisfactory functional outcomes. Eight patients (19.5%) required conversion to THA during follow-up, resulting in an overall THA-free survival rate of 85%. Survival analysis demonstrated 100% survivorship for anatomical reductions, 75% for imperfect reductions, and 0% for poor reductions. Fracture classification did not influence clinical outcomes but significantly affected long-term survivorship, with anterior column fractures showing 100% survival and transverse with posterior wall fractures showing the lowest at 50%.</div></div><div><h3>Conclusion</h3><div>The wiring technique offers a reliable and biologically favorable method for treating acetabular column fractures. It provides stable reduction with limited soft-tissue disruption, resulting in durable mid-term hip preservation and low complication rates. These findings emphasize the importance of achieving anatomical reduction and support the wiring technique as an effective option for managing acetabular column fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113016"},"PeriodicalIF":2.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981492","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}

{"title":"Biomechanical comparison of triangular osteosynthesis and triangular minimally invasive spinopelvic stabilization technique for pelvic fragility fractures","authors":"Hans-Joachim Riesner ,&nbsp;Jason DePhillips ,&nbsp;Amber R. Witt ,&nbsp;Jonathan M. Mahoney ,&nbsp;Brandon S. Bucklen","doi":"10.1016/j.injury.2026.113022","DOIUrl":"10.1016/j.injury.2026.113022","url":null,"abstract":"<div><h3>Objectives</h3><div>To biomechanically compare triangular osteosynthesis (TOS) and a minimally invasive triangular spinopelvic stabilization (TMSS) technique for Type IV fragility fractures of the pelvis (FFP) in a cadaveric model.</div></div><div><h3>Methods</h3><div>Six fresh-frozen lumbopelvic specimens (L3–pelvis; mean age 61.5 ± 11.5 yrs) with simulated Type IV U-shaped sacral fractures were sequentially instrumented with TOS (bilateral iliosacral screws + lumbopelvic fixation) and TMSS (bilateral iliac screws with transverse connecting rod + lumbopelvic fixation). Constructs were cyclically loaded (200–430 N; 25,000 cycles or 1 cm axial displacement) to simulate postoperative single-leg stance loading. Fracture displacement was quantified using a motion capture system.</div></div><div><h3>Results</h3><div>All but one TOS specimen completed 25,000 cycles. Bone mineral density had no effect on displacement. TMSS showed lower maximum fracture displacement (6.05 mm) than TOS (12.12 mm; <em>p</em>= 0.071). Displacement after 1000 cycles averaged 56% (TOS) and 62% (TMSS) of the maximum.</div></div><div><h3>Conclusions</h3><div>TMSS provided comparable or improved stability versus TOS and, with its minimally invasive design, may offer a viable alternative for FFP Type IV treatment. Further clinical validation is warranted.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113022"},"PeriodicalIF":2.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981494","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}

{"title":"Robotic-assisted versus fluoroscopy-guided sacroiliac screw fixation: A retrospective comparative study","authors":"Maria Auron ,&nbsp;Gal Barkay ,&nbsp;Ohad Einav ,&nbsp;David Laniado ,&nbsp;Yoram Weil ,&nbsp;Josh E Schroeder","doi":"10.1016/j.injury.2026.113019","DOIUrl":"10.1016/j.injury.2026.113019","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous sacroiliac (SI) screw fixation is a widely used technique for stabilizing sacral fractures but is considered technically demanding due to complex pelvic anatomy and proximity to neurovascular structures. Conventional fluoroscopy-guided methods are associated with a relatively high risk of screw misplacement and considerable radiation exposure to patients and staff. Robotic-assisted navigation systems have been introduced to enhance screw accuracy and reduce radiation exposure. The aim of this study was to assess the efficiency, safety, and accuracy of sacroiliac screw fixation using a robot-assisted method compared with a conventional freehand technique.</div></div><div><h3>Methods</h3><div>Medical records of patients treated with sacroiliac screw fixation for sacral fractures at a single Level 1 trauma center between December 2014 and August 2025 were retrospectively analyzed. Patients were divided into robotic-assisted and freehand fluoroscopy-guided groups for comparative analysis. Primary outcomes were intraoperative radiation exposure and operative time; secondary outcomes included screw position accuracy and complications. Statistical analysis was performed with significance set at <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Twenty-five patients (mean age: 57.7 ± 22.4 years) were included; 15 in the robotic-assisted and 10 in the conventional fluoroscopy-guided groups. A total of 47 SI-screws were inserted: 29 in the robotic group and 18 in the conventional group. Operative times were comparable between groups (47.1 ± 16.3 min and. 45.1 ± 30.0 min, respectively; <em>p</em> = 0.85). Compared to conventional fluoroscopy, robotic assistance was associated with reduced fluoroscopy time (55.1 ± 23.1 vs. 181.1 ± 104.4 s, p=0.053) and higher screw placement accuracy (94 % vs. 62 %, <em>p</em> = 0.06), although these did not reach statistical significance. No major intraoperative complications occurred.</div></div><div><h3>Conclusion</h3><div>Robotic-assisted navigation in sacroiliac screw insertion can potentially lower radiation exposure and improve screw placement accuracy compared to conventional techniques, without prolonging surgical time. These findings support robotic guidance as a safe and potentially more precise alternative for sacral fracture fixation. Further prospective studies should be performed to evaluate the possible benefits of robotic assisted sacroiliac screw fixation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113019"},"PeriodicalIF":2.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981570","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}

{"title":"Long term outcomes in periprosthetic femoral fractures: Experience from a UK district general hospital with a weekly dedicated periprosthetic theatre list and MDT approach","authors":"Avinash Kumar Rai ,&nbsp;Shaheer Mujahid ,&nbsp;Mohammed Suhail,&nbsp;Yash Jain,&nbsp;Rachael McManus,&nbsp;Anwar Jafri,&nbsp;Manju Ramappa,&nbsp;Antoni Nargol,&nbsp;Nick Cooke,&nbsp;Raghavendra Sidaginamale","doi":"10.1016/j.injury.2026.113015","DOIUrl":"10.1016/j.injury.2026.113015","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic femoral fractures (PFFs) are increasingly common as arthroplasty rates rise, with incidence projected to double in the next two decades. Mortality approaches that of hip fractures, with 1-year rates of 22–27 % reported in multicentre datasets. While favourable outcomes are often described from high-volume centres, most PFFs present to secondary care, where resources and surgical expertise may be limited. This study evaluates whether a structured multidisciplinary team (MDT) pathway with a weekly dedicated periprosthetic theatre list can achieve outcomes comparable to national and international benchmarks in a UK district hospital.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all PFFs managed between 2013 and 2024 at a district hospital (<em>n</em> = 258) in a trauma unit with fellowship trained arthroplasty surgeons, a dedicated Orthogeriatric team and weekly periprosthetic lists. Demographics, comorbidities (Charlson Comorbidity Index, ASA), fracture type (Vancouver classification), surgical management (fixation vs revision), and outcomes were analysed. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes included discharge destination, restoration of mobility, complications, and reoperation rates. Results were compared with national and international studies.</div></div><div><h3>Results</h3><div>Mean age was 80 years (median 82) with majority (60 %) being female. 213 (82.8 %) patients were managed operatively after multidisciplinary discussions. In-hospital mortality was 1.2 % (<em>n</em> = 3), 30-day mortality 3.5 %(<em>n</em> = 9) and one year mortality rate was 19.8 %. Mean CCI was 4.8 and one-year mortality was markedly higher in patients with CCI ≥4. Length of hospital stay increased progressively with surgical delay. Among those managed operatively, 63.5 % (<em>n</em> = 87) returned to their original place of residence.</div></div><div><h3>Conclusion</h3><div>A weekly dedicated periprosthetic list with MDT involvement allowed a district hospital to achieve mortality and functional outcomes equal to, or better than, those reported from high-volume centres. These findings highlight that system-level interventions, not hospital size, are the decisive factor in PFF outcomes, and provides a scalable model for hospitals globally.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113015"},"PeriodicalIF":2.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981574","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}

{"title":"Systematic literature reviews in trauma research: what is important to know?","authors":"Costas Papakostidis ,&nbsp;P.V. Giannoudis","doi":"10.1016/j.injury.2026.113014","DOIUrl":"10.1016/j.injury.2026.113014","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 113014"},"PeriodicalIF":2.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976448","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}

{"title":"A decade of trauma care in the North of Scotland: Impact of an inclusive network","authors":"Rosel Tallach ,&nbsp;Mark Hannen ,&nbsp;Tim Hooper ,&nbsp;Lee Allen ,&nbsp;Elaine Cole","doi":"10.1016/j.injury.2025.113012","DOIUrl":"10.1016/j.injury.2025.113012","url":null,"abstract":"<div><h3>Background</h3><div>Trauma care in Scotland is organised into four networks and the North of Scotland Trauma Network, covering 60 % of Scotland’s landmass, was the first of the four regions to go live in October 2018. The trauma demographics, journeys and outcomes over the decade of 2013-2023, five years and nine months prior to and five years post implementation were examined.</div></div><div><h3>Methods</h3><div>Data prospectively collected by Scottish Trauma Audit Group (STAG) during the time period was analysed. Patients of all ages, Injury Severity Score (ISS) &gt; 8 and head injury Abbreviated Injury Scale (AIS) &gt; 1 were included. The primary outcome was mortality. Multivariate logistic regression compared factors associated with mortality pre- and post – network.</div></div><div><h3>Results</h3><div>Post-network, 47.8 % of ISS&gt;15 presented at non-Major Trauma Centre (MTC) hospitals, of which 47.4 % underwent secondary transfer. Half (50.5 %) of serious head injuries (AIS&gt;2) presented to the Trauma Unit (TU) / Local Emergency Hospitals (LEH), of which 34.4 % were transferred to the MTC. Of those transferred to the MTC, moving vehicle was the commonest mechanism (44.7 %) and median ISS was 22 (IQR 17 - 29). Ultimately, the majority (75 %) of major trauma patients were treated at the MTC post network. Whilst overall mortality was 7.8 %; this rose to 18.3 % for ISS &gt; 15, and 20.6 % for serious head injury. Mortality for ISS &gt; 15 first presenting outside of the MTC and then subsequently transferred was 8.3 %. There was significant difference in 30-day mortality in those presenting after network implementation (OR 0.76 [0.6 – 0.97], <em>p</em> = 0.03) adjusting for age, ISS, head injury severity and mechanism of injury. A sensitivity analysis of the two consistently contributing hospitals (TU and MTC) was performed and mortality improvement was maintained (OR 0.71, 95 % CI 0.55 - 0.93, <em>p</em> = 0.011) although this could have been due to improved data capture of lower acuity trauma, or other confounding variables.</div></div><div><h3>Conclusion</h3><div>In a geographically dispersed network, the contributions of TUs and LEHs and subsequent secondary transfers are substantial. Network investment in training, communication pathways and transfer governance is essential.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 113012"},"PeriodicalIF":2.0,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884032","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}

{"title":"Postoperative outcomes based on timing of definitive fixation and flap coverage in Gustilo-Anderson 3B open tibia fractures","authors":"Benjamin Conover ,&nbsp;David Ferguson ,&nbsp;Brandon Wood ,&nbsp;Simon Tiziani ,&nbsp;Bingchun Wan ,&nbsp;Joshua Sun ,&nbsp;Drew Sanders ,&nbsp;Dane Wukich ,&nbsp;Adam Starr ,&nbsp;Ashoke Sathy ,&nbsp;Ishvinder Grewal","doi":"10.1016/j.injury.2025.113013","DOIUrl":"10.1016/j.injury.2025.113013","url":null,"abstract":"<div><h3>Objective</h3><div>Management of Gustilo 3B tibias remains problematic with high complication rate. Controversy persists about coverage timing, and whether the clock starts at time of injury or definitive fixation. Postoperative outcomes of 3B open tibia fractures and the effect of fixation and flap timing were reviewed retrospectively.</div></div><div><h3>Methods</h3><div><strong>Design:</strong> Retrospective observational study.</div><div><strong>Setting:</strong> Data derived from Bellwether PearlDiver, a multicenter insurance claims database.</div><div><strong>Patient Selection Criteria:</strong> 1066 Gustilo 3B tibia fractures were identified with flap coverage within 45 days of fixation (2009 ... 2021). Fixation within 3days of injury was classified as prompt. The remaining fixations were designated as delayed. Flap coverage within 3 days of fixation was considered prompt. Coverage after this was considered delayed.</div><div><strong>Outcome Measures and Comparisons:</strong> Complications and return to OR were analyzed. Separately, patients were divided by days to definitive fixation or days to flap coverage, irrespective to the other. One-year complication incidence was compared using linear regression analysis.</div></div><div><h3>Results</h3><div>252 (23.6 %) patients received prompt fixation and prompt flap. 519 (48.7 %) received prompt fixation and delayed flap. 271 (25.4 %) underwent both delayed fixation and flap while only 24 (2.3 %) received prompt flap following a delay in fixation. By linear regression analysis, surgical site infection (SSI), wound disruption (WD), and reoperation incidence increased by 0.53 % (p &lt; 0.001), 0.84 % (p &lt; 0.001), and 0.63 % (p &lt; 0.001), respectively, with each day between fixation and flap coverage. Days from injury to fixation was significant for increased WD incidence (0.38 %, p = 0.03).</div></div><div><h3>Conclusions</h3><div>Early flaps demonstrated fewer complications. Very few patients with delayed fixation received prompt flap coverage. Prior research suggested that delayed fixation had few consequences when followed by prompt flap coverage. This appears to be rare in practice. Prompt multidisciplinary orthopaedic and plastics management of Gustilo 3B tibia fractures is important for optimal outcomes in these injuries.</div><div><strong>Level of Evidence:</strong> Level 3</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 113013"},"PeriodicalIF":2.0,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884033","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}

{"title":"Polypharmacy, Outpatient Prescriptions and TBI Risk: a systematic review","authors":"Hadjer Dahel ,&nbsp;Han Ting Wang ,&nbsp;Christophe Dumais ,&nbsp;Guillaume Giraldeau ,&nbsp;Thien Sa Hoang ,&nbsp;Raoul Daoust ,&nbsp;Yiorgos Alexandros Cavayas ,&nbsp;Lisa Burry ,&nbsp;David Williamson","doi":"10.1016/j.injury.2025.113011","DOIUrl":"10.1016/j.injury.2025.113011","url":null,"abstract":"<div><h3>Introduction</h3><div>In recent decades, there has been a shift in TBI epidemiology, with a rising incidence in older adults. Medication use is an often-overlooked modifiable TBI risk factor. There is a paucity of research specifically examining the relationship between individual medications, polypharmacy, and the risk of TBI. With the goal of informing TBI prevention strategies as well as future research, we conducted a systematic review to assess the association between specific medication use, polypharmacy, and the risk of TBI.</div></div><div><h3>Materials and Methods</h3><div>This systematic review follows the PRISMA guidelines and was prospectively registered in PROSPERO. We conducted a literature search of the following databases: MEDLINE, EMBASE, PsycINFO, Global Health, CINAHL, and Web of Science. We included all randomized controlled, quasi-experimental or observational studies reporting on polypharmacy or single medications and the risk of TBI. We excluded pediatric studies, trauma studies that did not report specifically on TBI, animal studies, case series, and case reports. Reviewers independently evaluated studies according to inclusion and exclusion criteria and risk of bias.</div></div><div><h3>Results</h3><div>After duplicate removal, our research strategy identified 18,528 studies, of which 197 abstracts were selected for full-text review. Sixteen studies met our inclusion criteria. In total, 7 medication classes and 27 single medications were studied. A single study reported on polypharmacy. Four studies on antithrombotics reported an association with an increased risk of TBI. In 2 studies, antidepressants were associated with an increased risk of TBI. Two studies on antipsychotics showed an association with an increased risk of TBI. One study found a significant increase in the risk of TBI with the use of benzodiazepines. Results on z-drugs were inconsistent, with one study reporting a significant increase in TBI risk with zolpidem but not eszopiclone. The single study evaluating opioids reported an increased risk of TBI. Finally, antiarrhythmics were associated with an increased risk of TBI.</div></div><div><h3>Conclusion</h3><div>In robust studies, antipsychotics, antidepressants, hypnotics, and opioids have all been associated with an increased risk of TBI, while studies on antithrombotics are inconsistent. Further studies are needed to evaluate the risk of these drugs in the general population, especially in the elderly.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 113011"},"PeriodicalIF":2.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866868","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}

{"title":"Evaluation of trauma team activation criteria in Germany. A retrospective analysis of 94.000 cases from the TraumaRegister DGU®","authors":"Paul Hagebusch ,&nbsp;Rolf Lefering ,&nbsp;Daniel Anthony Koch ,&nbsp;Philipp Faul ,&nbsp;Philipp Störmann ,&nbsp;Dan Bieler ,&nbsp;Matthias Münzberg ,&nbsp;Uwe Schweigkofler","doi":"10.1016/j.injury.2025.113010","DOIUrl":"10.1016/j.injury.2025.113010","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective trauma triage relies on accurate trauma team activation (TTA) criteria to balance resource allocation and patient outcomes. Current guidelines prioritize high-risk of severe injury (HRSI) criteria, while moderate-risk of severe injury (MRSI) criteria are associated with high over-triage rates. Using data from the TraumaRegister DGU® (TR-DGU), this study evaluates the impact of different TTA criteria on patient outcomes and trauma system efficiency.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using TR-DGU data from 2018 to 2023, including patients aged ≥16 years with trauma team activation, emergency room treatment, and intensive or intermediate care admission. Patients were categorized based on TTA criteria: HRSI, MRSI, or provider decision (“None”). Injury severity, mortality, emergency interventions, intensive care unit (ICU) stay, and hospital length of stay were analyzed. Statistical comparisons utilized chi-square and Mann-Whitney-U tests, with significance set at <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>The final cohort included 97,295 patients: 42 % met HRSI criteria, 38 % MRSI, and 20 % were assigned due to provider decision. Patients in the HRSI group had the highest injury severity (ISS=23.5), mortality (19.3 %), and need for emergency interventions (31 %). In contrast, the MRSI group had significantly lower severity (ISS=12.5), mortality (1.6 %), and intervention rates (13 %). The \"None\" group, comprising mostly elderly patients with ground-level falls, had a higher mortality rate (8.5 %) despite a comparable ISS (13.5).</div></div><div><h3>Conclusion</h3><div>Findings highlight the limitations of MRSI-based TTA criteria, which contribute to resource overutilization without improving patient outcomes. A tiered activation strategy prioritizing HRSI while refining MRSI criteria may enhance triage efficiency. The high mortality rate in the \"None\" group suggests the need for additional triage parameters, particularly for geriatric patients. These insights support recent guideline revisions and are the basis for further evaluations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 113010"},"PeriodicalIF":2.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914344","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}