Injury-International Journal of the Care of the Injured最新文献_第5页

Construction and validation of a machine learning model based on clinical indicators: Risk of bloodstream infections in patients with deep second- and third-degree burns 基于临床指标的机器学习模型的构建和验证：深度二度和三度烧伤患者血液感染的风险

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-11 DOI: 10.1016/j.injury.2026.113046

Min Peng , ShaSha Zhang , DongFang Chang

Objective

Patients with deep second- and third-degree burns are at high risk of bloodstream infections (BSIs) due to skin barrier disruption and immune suppression, with poor prognosis. Early risk identification is crucial for improving outcomes. This study aimed to construct and validate a machine learning model using multidimensional clinical indicators to accurately predict BSI risk in such patients.

Methods

A retrospective cohort study enrolled 301 patients with deep second- and third-degree burns (75 with BSIs) from Yongchuan Hospital Affiliated to Chongqing Medical University between January 2020 and January 2025. Multidimensional data on burn characteristics, laboratory indicators, and therapeutic measures were collected within 72 h of admission. After data preprocessing and feature screening, four models were built: logistic regression (LR), support vector machine (SVM), naive Bayes (NB), and back propagation artificial neural network (BP-ANN). Model performance was evaluated via stratified sampling and 5-fold cross-validation.

Results

Eight key predictors were identified: total body surface area, lymphocytes (LYM, most important), platelet crit, total bilirubin, creatinine, C-reactive protein, procalcitonin, and 24-hour rehydration. The BP-ANN model performed best in the test set, with accuracy, recall, precision, F1 value, and AUC all reaching 0.857, good calibration (Hosmer-Lemeshow test, P = 0.142), and significant net benefit in the 0–0.3 risk threshold interval (decision curve analysis). The LR model had an AUC of 0.891 and high generalization stability (0.999) but less balanced indicators. SVM was overfitted (limited practical value), and NB had insufficient generalization (test set AUC=0.775).

Conclusion

The BP-ANN model based on multidimensional clinical indicators accurately predicts BSI risk in patients with deep second- and third-degree burns, with good differentiation, calibration, and clinical utility, providing a reliable tool for early intervention.

目的深二、三度烧伤患者由于皮肤屏障破坏和免疫抑制，是血流感染（bsi）的高危患者，预后较差。早期风险识别对于改善结果至关重要。本研究旨在构建并验证使用多维临床指标的机器学习模型，以准确预测此类患者的BSI风险。方法回顾性队列研究纳入了2020年1月至2025年1月重庆医科大学附属永川医院301例深度二、三度烧伤患者（75例伴有脑损伤）。入院72小时内收集烧伤特征、实验室指标和治疗措施的多维数据。经过数据预处理和特征筛选，建立了逻辑回归（LR）、支持向量机（SVM）、朴素贝叶斯（NB）和反向传播人工神经网络（BP-ANN） 4种模型。通过分层抽样和5次交叉验证来评估模型的性能。结果确定了8个关键预测因子：体表面积、淋巴细胞（LYM，最重要的）、血小板损伤、总胆红素、肌酐、c反应蛋白、降钙素原和24小时补液。BP-ANN模型在测试集中表现最好，准确率、召回率、精密度、F1值和AUC均达到0.857，校正效果好（Hosmer-Lemeshow检验，P = 0.142），在0-0.3风险阈值区间（决策曲线分析）净效益显著。LR模型的AUC为0.891，泛化稳定性较高（0.999），但指标不均衡。SVM过拟合（实用价值有限），NB泛化不足（测试集AUC=0.775）。结论基于多维临床指标的BP-ANN模型能够准确预测深度二、三度烧伤患者的BSI风险，具有良好的鉴别、校准和临床实用性，为早期干预提供了可靠的工具。

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引用次数: 0

Unstable Pelvic ring fractures managed surgically: A 13-year cohort study of patient characteristics, associated injuries, and predictors of early mortality 手术治疗不稳定骨盆环骨折：一项患者特征、相关损伤和早期死亡率预测因素的13年队列研究。

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-11 DOI: 10.1016/j.injury.2026.113051

Sebastian Skovdal Winther , Upender Martin Singh , Allan Evald Nielsen , Michael Mørk Petersen , Arvind von Keudell

Background and purpose

Unstable pelvic ring fractures are severe injuries with substantial mortality and a high burden of associated injuries. Advances in trauma care have improved outcomes. However, recent data from high-volume centers remain scarce. We aimed to evaluate mortality, associated injuries, and predictors of mortality in surgically treated unstable pelvic ring fractures.

Methods

We retrospectively analyzed 451 consecutive patients with surgically treated Tile B or C pelvic ring fractures admitted to a Level 1 trauma center between 2008 and 2021. Patient demographics, injury characteristics, and associated injuries were recorded. Kaplan–Meier methods were used to estimate survival, and Cox regression for identifying independent predictors of mortality.

Results

Overall mortality at 3-month was 4.2% (95% CI 2.3–6.0) and at 1-year at 6.0% (95% CI 3.8–8.2). Tile C fractures had a higher early mortality than Tile B (3-month: 6.5% vs. 2.1%; 1-year: 7.4% vs. 4.7%). Associated injuries were common: 78% of patients had at least one and 66% had two or more injured regions. Patients with injuries in ≥2 regions had markedly higher intensive care unit (ICU) admission, transfusion requirements, and early mortality. In multivariable Cox regression, age (HR 1.06 per year), Glascow Coma Scale (GCS) ≤8 (HR 4.9), and Tile C (HR 3.6) were independently associated with 90-day mortality.

Conclusion

Mortality after surgically treated unstable pelvic ring fractures at 3- month and 1 year was 4.2% and 6.0%, respectively. Age, low GCS, and Tile C fracture pattern were independent predictors of early death. Associated injuries and overall trauma burden were strongly associated with ICU admission, transfusion, and early mortality.

背景和目的：不稳定骨盆环骨折是一种严重的损伤，死亡率高，相关损伤负担高。创伤护理的进步改善了治疗效果。然而，最近来自高容量中心的数据仍然很少。我们的目的是评估手术治疗不稳定骨盆环骨折的死亡率、相关损伤和死亡率预测因素。方法：我们回顾性分析了2008年至2021年间在一级创伤中心连续收治的451例手术治疗的B或C级骨盆环骨折患者。记录患者人口统计、损伤特征和相关损伤。Kaplan-Meier法用于估计生存率，Cox回归用于确定死亡率的独立预测因子。结果：3个月的总死亡率为4.2% (95% CI 2.3-6.0)， 1年的总死亡率为6.0% （95% CI 3.8-8.2）。C片骨折的早期死亡率高于B片（3个月：6.5% vs. 2.1%； 1年：7.4% vs. 4.7%）。相关损伤很常见：78%的患者至少有一个区域受伤，66%的患者有两个或更多区域受伤。损伤≥2个区域的患者重症监护病房（ICU）入院率、输血需求和早期死亡率明显较高。在多变量Cox回归中，年龄（HR 1.06 /年）、Glascow昏迷量表(GCS)≤8 （HR 4.9）和Tile C （HR 3.6）与90天死亡率独立相关。结论：不稳定骨盆环骨折术后3个月和1年的死亡率分别为4.2%和6.0%。年龄、低GCS和Tile C骨折类型是早期死亡的独立预测因素。相关损伤和总体创伤负担与ICU入院、输血和早期死亡率密切相关。

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引用次数: 0

ICG-based fluorescence imaging to assess muscle perfusion for guiding surgical debridement after acute compartment syndrome 基于icg的荧光成像评估肌肉灌注指导急性筋膜间室综合征手术清创。

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-11 DOI: 10.1016/j.injury.2026.113039

Yue Tang , Shaofeng Yan , Shudong Jiang , Jonathan Thomas Elliott , Xu Cao , Lillian A. Fisher , Chelsey L. Recendez , Eric R. Henderson , Leah Gitajn

Background

Acute Compartment Syndrome (ACS) is a severe condition that can threaten limb viability, particularly in patients who experience prolonged immobility, such as in the found-down phenomenon. Inadequate removal of nonviable muscle after fasciotomy increases the risk of infection. While non-invasive imaging modalities have been explored for early ACS diagnosis, no tools currently exist to guide precise debridement intraoperatively. Existing technologies are limited by susceptibility to interference, lack of standardized thresholds and insufficient real-time surgical utility. This study aimed to evaluate the association between muscle perfusion, quantified by indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI), and the degree of muscle necrosis in ACS, assessed via histopathological analysis, to explore the potential of DCE-FI to guide intraoperative muscle debridement.

Methods

A total of 15 adults (aged 18 years or older) undergoing ACS surgical treatment were included in this study between 2023 and 2024. DCE-FI imaging was performed and eight muscle specimens spanning the entire length of the incision were obtained for each patient. Necrosis percentage was assigned to each sample based on histopathological evaluation by a pathologist. Patients were then classified into high necrosis (HN) and low necrosis (LN) groups based on their average necrosis scores from these eight samples, using 50 % necrosis as a cutoff. Perfusion-related kinetic parameters derived from DCE-FI, including maximum fluorescence intensity (I_max) and blood flow (BF), were evaluated and compared between the two groups.

Results

The HN group exhibited significantly lower I_max (p < 0.001) and BF (p < 0.001), compared to those in the LN group, indicating substantially reduced muscle perfusion. The HN group had significantly lower median values (I_max 23.0 RFUs, BF 1.9 mL/min/100g) compared to the LN group (I_max 32.4 RFUs, BF 3.1 mL/min/100g).

Conclusions

ICG-based DCE-FI demonstrated strong potential for intraoperative identification of muscle damage resulting from ACS. This technique may serve as a valuable adjunct for guiding surgical debridement which may minimize complications and reduce the number of debridement procedures required, particularly in challenging cases of delayed or missed diagnosis of compartment syndrome.

背景：急性筋膜间室综合征（ACS）是一种严重的疾病，可威胁肢体的生存能力，特别是在经历长期不活动的患者中，如发现倒下现象。筋膜切开术后不适当切除不存活的肌肉会增加感染的风险。虽然非侵入性成像方式已被用于早期ACS诊断，但目前还没有工具可以指导术中精确清创。现有的技术受制于易受干扰、缺乏标准化阈值和实时手术效用不足。本研究旨在评价以吲哚菁绿（ICG）为基础的动态对比增强荧光成像（DCE-FI）量化的肌肉灌注与ACS的肌肉坏死程度之间的关系，并通过组织病理学分析评估，探讨DCE-FI指导术中肌肉清创的潜力。方法：在2023年至2024年期间，共纳入15名接受ACS手术治疗的成年人（18岁或以上）。进行DCE-FI成像，为每位患者获得8个横跨整个切口长度的肌肉标本。根据病理学家的组织病理学评估，分配每个样本的坏死百分比。然后根据这8个样本的平均坏死评分将患者分为高坏死（HN）组和低坏死（LN）组，坏死以50%为截止值。DCE-FI获得的灌注相关动力学参数，包括最大荧光强度（Imax）和血流量（BF），进行评估和比较。结果：与LN组相比，HN组的Imax （p < 0.001）和BF （p < 0.001）明显降低，表明肌肉灌注明显减少。与LN组（Imax 32.4 RFUs, BF 3.1 mL/min/100g）相比，HN组的中位值（Imax 23.0 RFUs, BF 1.9 mL/min/100g）显著降低。结论：基于icg的DCE-FI显示了术中识别ACS引起的肌肉损伤的强大潜力。该技术可作为指导手术清创的一种有价值的辅助手段，可以最大限度地减少并发症，减少所需的清创手术次数，特别是在延迟或漏诊筋膜间室综合征的挑战性病例中。

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引用次数: 0

Multiple iliosacral screws in a single osseous fixation pathway: Utility and safety 在单一骨固定通路中使用多个髂骶螺钉：实用性和安全性

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-10 DOI: 10.1016/j.injury.2026.113023

David A Zuelzer , Andrew Coskey , Yugant Patel , Christopher Meuth , Milton L “Chip” Routt , Raymond D. Wright

Objectives

1) To evaluate common characteristics for injuries treated with multiple iliosacral screws in a single sacral osseous pathway to evaluate when it may be useful and 2) to determine whether placing multiple iliosacral screws in a single sacral OFP increases risk for unsafe screws.

Methods

Design: Retrospective, combined case-control and cohort analyses

Setting: Single, Level 1 regional trauma center

Patient Selection Criteria: Treated with iliosacral screws identified by CPT code search 27,216 and 27218

Outcome Measures and Variables: Population was divided into multiple screw (MS) and single screw (SS) groups. Outcomes of interest were factors associated with MS group and screw safety on postoperative CT scan.

Results

There were 133 patients with 53/133 (39.8%) in the MS group and 80/133 (60.2%) in the SS group. On logistic regression, each 2-mm increase in CT measurement was associated with higher odds of receiving multiple screws for sacroiliac style (OR = 1.34, 95% CI 1.05–1.71, p = 0.02) or transsacral if non-dysmorphic (OR = 1.55, 95% CI 1.25–1.93, p < 0.001) in S1. Patients were 3.4 times more likely to be in the MS group with C-type than B-type injuries (OR = 3.40, 95%CI 1.61–7.22, p = 0.0014). MS was not a risk factor for juxtacortical or extraosseous screw placement (RR = 1.93, 95%CI 0.66–5.65, p = 0.23).

Conclusion

The results of this study suggest that surgeons may place multiple iliosacral screws in a single OFP in more complex or unstable injuries and/or when larger safe corridors exist on preoperative imaging and that multiple iliosacral screws may not be associated with an increase in risk for unsafe screw placement.

目的1)评估在单一骶骨通路中使用多枚髂骶螺钉治疗损伤的共同特征，以评估何时可能有用；2)确定在单一骶骨OFP中放置多枚髂骶螺钉是否会增加不安全螺钉的风险。设计：回顾性、病例对照和队列分析。设置：单一、1级区域性创伤中心。患者选择标准：使用经CPT编码检索27216和27218确定的髂骶螺钉治疗。结果测量和变量：人群分为多螺钉组（MS）和单螺钉组（SS）。关注的结果是与MS组和术后CT扫描螺钉安全性相关的因素。结果133例患者中，MS组53/133例（39.8%），SS组80/133例（60.2%）。在logistic回归中，CT测量值每增加2mm，骶髂畸形（OR = 1.34, 95% CI 1.05-1.71, p = 0.02）或经骶畸形（OR = 1.55, 95% CI 1.25-1.93, p < 0.001）接受多螺钉治疗的几率就会增加。MS组患者出现c型损伤的可能性是b型损伤的3.4倍（OR = 3.40, 95%CI 1.61 ~ 7.22, p = 0.0014）。MS不是皮质旁或骨外置入螺钉的危险因素（RR = 1.93, 95%CI 0.66-5.65, p = 0.23）。结论本研究的结果表明，在更复杂或不稳定的损伤和/或术前影像学存在较大安全通道的情况下，外科医生可以在单个OFP内放置多枚髂骶螺钉，并且多枚髂骶螺钉可能不会增加不安全螺钉放置的风险。

{"title":"Multiple iliosacral screws in a single osseous fixation pathway: Utility and safety","authors":"David A Zuelzer , Andrew Coskey , Yugant Patel , Christopher Meuth , Milton L “Chip” Routt , Raymond D. Wright","doi":"10.1016/j.injury.2026.113023","DOIUrl":"10.1016/j.injury.2026.113023","url":null,"abstract":"<div><h3>Objectives</h3><div>1) To evaluate common characteristics for injuries treated with multiple iliosacral screws in a single sacral osseous pathway to evaluate when it may be useful and 2) to determine whether placing multiple iliosacral screws in a single sacral OFP increases risk for unsafe screws.</div></div><div><h3>Methods</h3><div>Design: Retrospective, combined case-control and cohort analyses</div><div><em>Setting:</em> Single, Level 1 regional trauma center</div><div><em>Patient Selection Criteria:</em> Treated with iliosacral screws identified by CPT code search 27,216 and 27218</div><div><em>Outcome Measures and Variables:</em> Population was divided into multiple screw (MS) and single screw (SS) groups. Outcomes of interest were factors associated with MS group and screw safety on postoperative CT scan.</div></div><div><h3>Results</h3><div>There were 133 patients with 53/133 (39.8%) in the MS group and 80/133 (60.2%) in the SS group. On logistic regression, each 2-mm increase in CT measurement was associated with higher odds of receiving multiple screws for sacroiliac style (OR = 1.34, 95% CI 1.05–1.71, <em>p</em> = 0.02) or transsacral if non-dysmorphic (OR = 1.55, 95% CI 1.25–1.93, <em>p</em> < 0.001) in S1. Patients were 3.4 times more likely to be in the MS group with C-type than B-type injuries (OR = 3.40, 95%CI 1.61–7.22, <em>p</em> = 0.0014). MS was not a risk factor for juxtacortical or extraosseous screw placement (RR = 1.93, 95%CI 0.66–5.65, <em>p</em> = 0.23).</div></div><div><h3>Conclusion</h3><div>The results of this study suggest that surgeons may place multiple iliosacral screws in a single OFP in more complex or unstable injuries and/or when larger safe corridors exist on preoperative imaging and that multiple iliosacral screws may not be associated with an increase in risk for unsafe screw placement.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113023"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981569","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}

引用次数: 0

Injectable thermosensitive hydrogel delivering resveratrol protects articular cartilage via SIRT1/HIF1α/MMP13 signaling 可注射热敏水凝胶传递白藜芦醇通过SIRT1/HIF1α/MMP13信号保护关节软骨

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-10 DOI: 10.1016/j.injury.2026.113040

Mao Xu , Xin Gao , Shujin Li , Xuhuizi Liu , Bing Li , Xinxin Jin

Background

Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, synovial inflammation and subchondral bone sclerosis. There is currently no effective drug treatments for late stage OA.

Methods

Here, we prepare injectable resveratrol (Res) thermosensitive hydrogels, detect its microscopic morphology and release in vitro. Then observing its therapeutic effect on C57BL/6 mice in vivo and femoral heads in vitro also used. Characterization of temperature-sensitive resveratrol gel, chondrosynthesis and catabolism genes, morphology of joint and femoral head from mice. Expression of sirtuin1(SIRT1) and hypoxia inducible factor-1α (HIF1α) is also detected in vivo and in vitro. IL-1β is used to imitate an in vitro osteoarthritis model.

Results

Res hydrogels show excellent strain, injectability and temperature sensitive properties, and have an apparent protective effect on the OA articular cartilage. P53 and P21 elevated in DMM mice, when HIF1α and matrix metalloproteinase 13 (MMP13) both increased similarly. While Res activates SIRT1 by suppressing HIF1α nucleus-shuttling to promote chondrocytes proliferation and reduce hypertrophy.

Conclusion

Taken together, injectable resveratrol thermosensitive hydrogel protects the articular cartilage from degradation and reduces the damage to joints caused by mechanical stress via SIRT1/ HIF1α/MMP13 pathway.

骨关节炎（OA）是一种以关节软骨退行性变、滑膜炎症和软骨下骨硬化为特征的慢性关节疾病。目前尚无有效的药物治疗晚期OA。方法制备注射用白藜芦醇（Res）热敏水凝胶，检测其显微形态和体外释放度。然后观察其对C57BL/6小鼠体内和体外股骨头的治疗作用。温度敏感白藜芦醇凝胶的表征，软骨合成和分解代谢基因，小鼠关节和股骨头形态。体内和体外也检测了sirtuin1（SIRT1）和缺氧诱导因子-1α (HIF1α)的表达。IL-1β用于体外模拟骨关节炎模型。结果res水凝胶具有良好的应变性、注射性和温敏性，对骨性关节炎关节软骨具有明显的保护作用。P53和P21在DMM小鼠中升高，HIF1α和基质金属蛋白酶13 （MMP13）也同样升高。而Res通过抑制HIF1α核穿梭激活SIRT1，促进软骨细胞增殖，减少肥大。结论注射用白藜芦醇热敏水凝胶可通过SIRT1/ HIF1α/MMP13途径保护关节软骨降解，减轻机械应力对关节的损伤。

{"title":"Injectable thermosensitive hydrogel delivering resveratrol protects articular cartilage via SIRT1/HIF1α/MMP13 signaling","authors":"Mao Xu , Xin Gao , Shujin Li , Xuhuizi Liu , Bing Li , Xinxin Jin","doi":"10.1016/j.injury.2026.113040","DOIUrl":"10.1016/j.injury.2026.113040","url":null,"abstract":"<div><h3>Background</h3><div>Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, synovial inflammation and subchondral bone sclerosis. There is currently no effective drug treatments for late stage OA.</div></div><div><h3>Methods</h3><div>Here, we prepare injectable resveratrol (Res) thermosensitive hydrogels, detect its microscopic morphology and release <em>in vitro</em>. Then observing its therapeutic effect on C57BL/6 mice <em>in vivo</em> and femoral heads <em>in vitro</em> also used. Characterization of temperature-sensitive resveratrol gel, chondrosynthesis and catabolism genes, morphology of joint and femoral head from mice. Expression of sirtuin1(SIRT1) and hypoxia inducible factor-1α (HIF1α) is also detected <em>in vivo</em> and <em>in vitro</em>. IL-1β is used to imitate an <em>in vitro</em> osteoarthritis model.</div></div><div><h3>Results</h3><div>Res hydrogels show excellent strain, injectability and temperature sensitive properties, and have an apparent protective effect on the OA articular cartilage. P53 and P21 elevated in DMM mice, when HIF1α and matrix metalloproteinase 13 (MMP13) both increased similarly. While Res activates SIRT1 by suppressing HIF1α nucleus-shuttling to promote chondrocytes proliferation and reduce hypertrophy.</div></div><div><h3>Conclusion</h3><div>Taken together, injectable resveratrol thermosensitive hydrogel protects the articular cartilage from degradation and reduces the damage to joints caused by mechanical stress via SIRT1/ HIF1α/MMP13 pathway.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113040"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981623","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}

引用次数: 0

Measurement properties of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for patella fractures 髌骨骨折的膝关节损伤和骨关节炎结局评分（oos）的测量特性

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-10 DOI: 10.1016/j.injury.2026.113033

Peter Larsen , Rasmus Jorgensen , Martin Jensen , Soeren Lundbye-Christensen , Rasmus Elsoe

Background

The study aimed to investigate relevance, construct validity, reliability, and responsiveness and estimate the minimal clinically important difference of the Knee Injury and Osteoarthritis Outcome Score (KOOS) to adult patients with patella fractures.

Materials and methods

The study design was a prospective cohort study including patients treated conservatively and surgically following a patella fracture (AO-34). The primary outcome measure was the KOOS. The KOOS was repeated at 14 days, 15 days, six weeks, and finally at six and 12 months. Relevance was evaluated by patients and surgeons ranking of relevance of the 42 items in the KOOS, construct validity by correlation to Eq5d, test-retest reliability by an interclass correlation coefficient, and responsiveness by a priori hypothesis and supplemented by effect size. Furthermore, estimation of minimal clinically important difference (MCID) based on longitudinal confirmatory factor analysis.

Results

Included were 65 patients with a mean age of 63.3 years (range 24 to 89) with 74 % female gender. Results showed an acceptable relevance and construct validity. The test-retest reliability was high for all five subscales, with an interclass correlation coefficient ranging from 0.8 to 0.9. Evaluation of responsiveness showed high correlation to the predefined hypothesis (r < 0.6) and moderate to large effect sizes. The MCID of the KOOS subscales were Pain 7.0 (1.6 - 9.8), Symptoms 7.3 (2.0 - 12.6), ADL11.8 (3.2 - 16.0), Sport/Rec 9.3 (3.4 - 15.3) and QOL 8.8 (6.1 - 17.8).

Conclusion

The Knee Injury and Osteoarthritis Outcome Score (KOOS) showed acceptable relevance, construct validity and responsiveness and high reliability to adult patients with patella fractures.

本研究旨在探讨成年髌骨骨折患者膝关节损伤和骨关节炎结局评分（oos）的相关性、构建效度、信度和反应性，并评估其在临床上的最小重要差异。材料和方法研究设计为前瞻性队列研究，包括髌骨骨折后保守治疗和手术治疗的患者（AO-34）。主要结局指标为kos。分别在第14天、第15天、第6周、最后在第6个月和第12个月进行oos。通过患者和外科医生对kos中42个条目的相关性排序来评估相关性，通过与Eq5d的相关性来评估结构效度，通过类间相关系数来评估重测信度，通过先验假设并辅以效应大小来评估反应性。此外，基于纵向验证性因子分析的最小临床重要差异（MCID）估计。结果纳入65例患者，平均年龄63.3岁（24 ~ 89岁），女性占74%。结果显示了可接受的相关性和结构效度。五个分量表的重测信度均较高，类间相关系数在0.8 ~ 0.9之间。对反应性的评估显示与预先设定的假设高度相关（r < 0.6），并且具有中等到较大的效应量。KOOS亚量表的MCID分别为疼痛7.0（1.6 ~ 9.8）、症状7.3（2.0 ~ 12.6）、ADL11.8（3.2 ~ 16.0）、Sport/Rec 9.3（3.4 ~ 15.3）和QOL 8.8（6.1 ~ 17.8）。结论膝关节损伤与骨关节炎预后评分（oos）对成年髌骨骨折患者具有良好的相关性、结构效度和反应性，可靠性较高。

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引用次数: 0

Prevalence of dysmorphic sacral features in the general population 一般人群中骶骨畸形的患病率

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-10 DOI: 10.1016/j.injury.2026.113048

Ian Meshay , Katelyn A. Cole , Sabrina M. Pescatore , Kaley Haney , John C. Hagedorn II

Background

Posterior pelvic ring injuries, including sacral fractures and sacroiliac (SI) joint disruption, can have potentially serious sequelae and are becoming increasingly common. Management, especially in the setting of instability, consists of internal fixation to decrease the risk of complications. Placement of SI screws requires a thorough knowledge of normal pelvic anatomy and the available osseous fixation pathways. The aim of this study was to define the prevalence of individual features of sacral dysmorphism in the general population.

Methods

We conducted a retrospective review of standard and 3D-reconstructed computed tomography (CT) images of the pelvis to record the presence or absence of each dysmorphic feature. All adult trauma patients who presented within a 5-year period at a single, academic, Level I trauma center were eligible for inclusion. Patients <18 years of age, without advanced pelvic imaging, or who presented with any current or prior pelvic ring injury, tumor, or instrumentation were excluded. The prevalence of each dysmorphic feature was calculated and associations between dysmorphism and demographic factors were investigated.

Results

A total of 2667 patients were eligible for inclusion and the first 1000 were selected for review. Six subjects were excluded during review of CT images. One or more dysmorphic feature was seen in 96.8% of subjects. Each subject displayed an average of 2.7 abnormal features. Residual S1 discs were the most prevalent feature (72.2%). While tongue-in-groove (TIG) sacroiliac (SI) joints were the rarest (7.7% prevalence), they were associated with a significantly higher average number of concurrent dysmorphic features (3.29, P < .0001). Demographic subgroup analysis demonstrated a significantly higher prevalence of S1 discs (P = .0007), TIG SI joints (P < .0001), and colinear upper sacra (P < .0001) in women. Residual S1 discs were also significantly more common in White patients (P < .0001).

Conclusions

Sacral anatomy exists on a spectrum from normal to dysmorphic. This study demonstrates that completely “normal” sacral morphology is seen in <4% of patients. TIG sacroiliac joints may serve as a quick indicator for a higher degree of dysmorphism which may complicate or preclude transiliac-transsacral screw placement.

骨盆后环损伤，包括骶骨骨折和骶髂（SI）关节断裂，可能有潜在的严重后遗症，并且变得越来越普遍。治疗，特别是在不稳定的情况下，包括内固定以减少并发症的风险。放置SI螺钉需要对正常骨盆解剖和可用的骨固定途径有全面的了解。本研究的目的是确定一般人群中骶骨畸形的个体特征的患病率。方法回顾性分析骨盆的标准和三维重建CT图像，记录每种畸形特征的存在或不存在。所有5年内在单一学术一级创伤中心就诊的成人创伤患者均符合入选条件。排除年龄在18岁，没有盆腔显像，或目前或既往有盆腔环损伤、肿瘤或内固定的患者。计算了每种畸形特征的患病率，并调查了畸形与人口因素之间的关系。结果共有2667例患者符合纳入条件，前1000例患者入选。6名受试者在复查CT图像时被排除在外。96.8%的受试者出现一个或多个畸形特征。每个受试者平均表现出2.7个异常特征。残余S1椎间盘是最常见的特征（72.2%）。虽然舌槽型（TIG）骶髂（SI）关节是最罕见的（患病率为7.7%），但它们与并发畸形特征的平均数量显著增加相关（3.29,P < .0001）。人口统计学亚组分析显示，女性中S1椎间盘（P = 0.0007）、TIG - SI关节（P < 0.0001）和上骶骨共线（P < 0.0001）的患病率明显较高。残余S1椎间盘在白人患者中也更为常见（P < .0001）。结论骶骨解剖存在从正常到畸形的谱系。这项研究表明，在4%的患者中可以看到完全“正常”的骶骨形态。骶髂关节TIG可作为高度畸形的快速指标，这种畸形可能使经髂-经骶螺钉置入复杂化或排除。

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引用次数: 0

Impact of surgical timing on perioperative outcomes after open reduction and internal fixation of periprosthetic proximal femoral fractures 手术时机对股骨近端假体周围骨折切开复位内固定围手术期疗效的影响

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-10 DOI: 10.1016/j.injury.2026.113049

Christopher Lampert, Leon Faust, Tobias Helfen, Carl Neuerburg, Boris Michael Holzapfel, Wolfgang Böcker, Eduardo Suero , Florian Pachmann

Background

Periprosthetic proximal femoral fractures (PPFF) are expected to increase substantially due to demographic changes and the rising number of total hip arthroplasties. While early surgery is clearly recommended for native hip fractures, the optimal timing of surgery for PPFF remains controversial. The present study aimed to evaluate the effect of early versus delayed surgery on perioperative outcomes in patients with PPFF treated by open reduction and internal fixation (ORIF).

Methods

We conducted a retrospective analysis of 110 patients with PPFF who underwent ORIF at a Level 1 trauma center between January 2017 and August 2023. We analyzed the effect of early (within 24 hours) versus delayed (after 24 hours) surgical treatment after admission on the primary outcome measures: surgical and non-surgical complications, reoperation rate, in-hospital mortality, and postoperative immobility. Secondary outcome measures included the duration of surgery, length of hospital stay, and bleeding complications.

Results

Baseline demographics, comorbidities, and fracture patterns were comparable between the groups. No significant differences were observed in surgical (18.2 % vs. 14.6 %; p = 0.622) and non-surgical (27.3 % vs. 27.3 %; p = 0.992) complication rates, length of hospital stay (15.6 ± 13.5 vs. 15.4 ± 8.2 days; p = 0.747), reoperation rates (14.6 % vs. 10.9 %; p = 0.621). In-hospital mortality was low (7.3 % vs. 5.5 %; p = 0.672) and was not affected by the time of surgery. A longer operative time in patients undergoing surgery within 24 hours (150.5 ± 56.6 vs. 115.9 ± 54.6 min; p = 0.001) was not associated with an increase in morbidity or mortality.

Conclusion

Timing of surgical intervention had no impact on perioperative outcomes in patients with PPFF treated with ORIF. However, considering the elderly and frail nature of this patient population, timely surgery should be recommended to enable early mobilization, which is essential for preventing complications and may improve long-term functional outcomes.

背景：由于人口结构的变化和全髋关节置换术数量的增加，股骨近端假体周围骨折（PPFF）预计将大幅增加。虽然早期手术被明确推荐用于治疗先天性髋部骨折，但PPFF的最佳手术时机仍存在争议。本研究旨在评估早期手术与延迟手术对经切开复位内固定（ORIF）治疗的PPFF患者围手术期结局的影响。方法回顾性分析2017年1月至2023年8月在某一级创伤中心接受ORIF治疗的110例PPFF患者。我们分析了入院后早期（24小时内）和延迟（24小时后）手术治疗对主要结局指标的影响：手术和非手术并发症、再手术率、住院死亡率和术后不动。次要结局指标包括手术时间、住院时间和出血并发症。结果两组之间的基线人口统计学、合并症和骨折模式具有可比性。手术（18.2%比14.6%,p = 0.622）和非手术（27.3%比27.3%,p = 0.992）并发症发生率、住院时间（15.6±13.5比15.4±8.2天，p = 0.747）、再手术率（14.6%比10.9%,p = 0.621）差异无统计学意义。住院死亡率较低（7.3%对5.5%;p = 0.672），且不受手术时间的影响。24小时内接受手术的患者手术时间较长（150.5±56.6 vs 115.9±54.6 min; p = 0.001）与发病率或死亡率的增加无关。结论手术干预时机对经ORIF治疗的PPFF患者围手术期预后无影响。然而，考虑到这类患者的年老体弱，应建议及时手术以实现早期活动，这对于预防并发症和改善长期功能预后至关重要。

{"title":"Impact of surgical timing on perioperative outcomes after open reduction and internal fixation of periprosthetic proximal femoral fractures","authors":"Christopher Lampert, Leon Faust, Tobias Helfen, Carl Neuerburg, Boris Michael Holzapfel, Wolfgang Böcker, Eduardo Suero , Florian Pachmann","doi":"10.1016/j.injury.2026.113049","DOIUrl":"10.1016/j.injury.2026.113049","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic proximal femoral fractures (PPFF) are expected to increase substantially due to demographic changes and the rising number of total hip arthroplasties. While early surgery is clearly recommended for native hip fractures, the optimal timing of surgery for PPFF remains controversial. The present study aimed to evaluate the effect of early versus delayed surgery on perioperative outcomes in patients with PPFF treated by open reduction and internal fixation (ORIF).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 110 patients with PPFF who underwent ORIF at a Level 1 trauma center between January 2017 and August 2023. We analyzed the effect of early (within 24 hours) versus delayed (after 24 hours) surgical treatment after admission on the primary outcome measures: surgical and non-surgical complications, reoperation rate, in-hospital mortality, and postoperative immobility. Secondary outcome measures included the duration of surgery, length of hospital stay, and bleeding complications.</div></div><div><h3>Results</h3><div>Baseline demographics, comorbidities, and fracture patterns were comparable between the groups. No significant differences were observed in surgical (18.2 % vs. 14.6 %; p = 0.622) and non-surgical (27.3 % vs. 27.3 %; p = 0.992) complication rates, length of hospital stay (15.6 ± 13.5 vs. 15.4 ± 8.2 days; p = 0.747), reoperation rates (14.6 % vs. 10.9 %; p = 0.621). In-hospital mortality was low (7.3 % vs. 5.5 %; p = 0.672) and was not affected by the time of surgery. A longer operative time in patients undergoing surgery within 24 hours (150.5 ± 56.6 vs. 115.9 ± 54.6 min; p = 0.001) was not associated with an increase in morbidity or mortality.</div></div><div><h3>Conclusion</h3><div>Timing of surgical intervention had no impact on perioperative outcomes in patients with PPFF treated with ORIF. However, considering the elderly and frail nature of this patient population, timely surgery should be recommended to enable early mobilization, which is essential for preventing complications and may improve long-term functional outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113049"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950139","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}

引用次数: 0

Chronic acromio-clavicular dislocation: Bi-modal stabilization 慢性肩锁关节脱位：双峰稳定。

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-10 DOI: 10.1016/j.injury.2026.113035

Ahmed Farid Mekky, Mohammed Sadakah, Hosam Mohamed Ghaly, Mohamed Rohayem, Mohammed Roshdy El-Tabbakh

Background:

Chronic acromio-clavicular dislocation is a challenging injury to treat. Many surgical procedures are available for its management which may be anatomical or non-anatomical. The aim of this study was to assess the clinical and radiological outcome in the patients with chronic acromio-clavicular dislocation treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures.

Methods:

From July 2021 to January 2025, 21 patients with chronic acromio-clavicular dislocation were treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures. Grade III to VI chronic acromio-clavicular injuries were included. Post-operatively, the patients were clinically assessed using Constant shoulder and Acromio-clavicular joint instability scores. Acromio-clavicular arthritis, coraco-clavicular ossification, distal clavicle osteolysis, coraco-clavicular and acromio-clavicular distances were radiologically evaluated.

Results:

The mean age at time of surgery was 28.52 ± 8.0 (range: 19-45) years. The acromio-clavicular dislocation was type III in 7 patients (33.4 %), type IV in 12 patients ( %57.1) and type V in 2 patients (9.5 %). The mean follow-up period was 24.29 ± 3.51 (range: 18-30) months. The mean post-operative Acromio-clavicular joint instability and Constant shoulder scores were 93.14 ± 8.16 (range: 78-100) and 90.14 ± 8.16 (range: 80-100) points respectively. None of the patients showed recurrent dislocation, arthritis and distal clavicle osteolysis.

Conclusion:

Bi-modal stabilization using hybrid biological semitendinosus autograft and synthetic non-absorbable sutures is an effective and reliable surgical option to treat chronic acromio-clavicular dislocation. Most of the reported complications associated with this procedure didn’t affect the functional outcome.

背景：慢性肩锁脱位是一种具有挑战性的损伤治疗。许多外科手术可用于其管理，可能是解剖或非解剖。本研究的目的是评估混合生物自体半腱肌和合成不可吸收缝合线治疗慢性肩锁关节脱位的临床和影像学结果。方法：自2021年7月至2025年1月，对21例慢性肩锁关节脱位患者采用自体生物半腱骨复合人工不可吸收缝合线进行治疗。包括III至VI级慢性肩锁损伤。术后，采用恒肩和肩锁关节不稳定性评分对患者进行临床评估。肩胛骨-锁骨关节炎、喙-锁骨骨化、锁骨远端骨溶解、喙-锁骨和肩锁距离进行影像学评估。结果：手术时平均年龄28.52±8.0岁（范围：19-45岁）。肩锁关节脱位为III型7例（33.4%），IV型12例（% 57.1%），V型2例（9.5%）。平均随访时间为24.29±3.51（18-30）个月。术后肩锁关节不稳定性和肩部常数评分平均分别为93.14±8.16分（范围：78-100）和90.14±8.16分（范围：80-100）。所有患者均无复发性脱位、关节炎及锁骨远端骨溶解。结论：自体半腱肌生物混合植骨和合成不可吸收缝线的双峰稳定是治疗慢性肩锁关节脱位的有效、可靠的手术选择。大多数报道的与该手术相关的并发症不影响功能结果。

{"title":"Chronic acromio-clavicular dislocation: Bi-modal stabilization","authors":"Ahmed Farid Mekky, Mohammed Sadakah, Hosam Mohamed Ghaly, Mohamed Rohayem, Mohammed Roshdy El-Tabbakh","doi":"10.1016/j.injury.2026.113035","DOIUrl":"10.1016/j.injury.2026.113035","url":null,"abstract":"<div><h3>Background:</h3><div>Chronic acromio-clavicular dislocation is a challenging injury to treat. Many surgical procedures are available for its management which may be anatomical or non-anatomical. The aim of this study was to assess the clinical and radiological outcome in the patients with chronic acromio-clavicular dislocation treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures.</div></div><div><h3>Methods:</h3><div>From July 2021 to January 2025, 21 patients with chronic acromio-clavicular dislocation were treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures. Grade III to VI chronic acromio-clavicular injuries were included. Post-operatively, the patients were clinically assessed using Constant shoulder and Acromio-clavicular joint instability scores. Acromio-clavicular arthritis, coraco-clavicular ossification, distal clavicle osteolysis, coraco-clavicular and acromio-clavicular distances were radiologically evaluated.</div></div><div><h3>Results:</h3><div>The mean age at time of surgery was 28.52 ± 8.0 (range: 19-45) years. The acromio-clavicular dislocation was type III in 7 patients (33.4 %), type IV in 12 patients ( %57.1) and type V in 2 patients (9.5 %). The mean follow-up period was 24.29 ± 3.51 (range: 18-30) months. The mean post-operative Acromio-clavicular joint instability and Constant shoulder scores were 93.14 ± 8.16 (range: 78-100) and 90.14 ± 8.16 (range: 80-100) points respectively. None of the patients showed recurrent dislocation, arthritis and distal clavicle osteolysis.</div></div><div><h3>Conclusion:</h3><div>Bi-modal stabilization using hybrid biological semitendinosus autograft and synthetic non-absorbable sutures is an effective and reliable surgical option to treat chronic acromio-clavicular dislocation. Most of the reported complications associated with this procedure didn’t affect the functional outcome.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113035"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014128","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}

引用次数: 0

Diagnostic test accuracy of CT for open globe injury: A systematic review and meta-analysis of overall impression and individual imaging signs CT对开放性球损伤的诊断测试准确性：对整体印象和个体影像学征象的系统回顾和荟萃分析

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-01-10 DOI: 10.1016/j.injury.2026.113041

Mahmoud Omar , Nailah Ghouse , Alexander Azar , Sarah Atta , Wassim Malak

Introduction

Open globe injury is a surgical emergency requiring prompt diagnosis to minimize morbidity. Orbital CT is frequently performed in trauma settings and is crucial for globe evaluation, particularly when bedside assessment is limited.

The primary objective was to evaluate the diagnostic accuracy of overall CT impression for detecting open globe injury. The secondary objective was to assess the diagnostic accuracy of CT imaging signs.

Methods

A systematic review protocol was prospectively registered (PROSPERO CRD42025638703). On January 16, 2025, Embase, Pubmed, Scopus, and Google Scholar were searched without date restrictions. Diagnostic accuracy meta-analyses were performed on overall CT impression and individual CT imaging signs for open globe injury. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Results

Eight studies met inclusion criteria representing 827 patients, 830 injured globes, and 339 confirmed open globe injury. The pooled sensitivity and specificity of overall CT impression was 75% (95% CI, 0.69–0.79) and 94% (95% CI, 0.91–0.96), respectively. Among individual signs, change in globe contour or scleral irregularity had the highest diagnostic odds ratio (109; 95% CI, 17–718) with sensitivity and specificity of 71% (95% CI, 0.61–0.79) and 98% (95% CI, 0.86–1.00), respectively. Change in anterior chamber depth, vitreous hemorrhage, lens abnormality, and intraocular air were insensitive but highly specific signs.

Conclusions

Overall CT impression and individual imaging signs demonstrate high specificity but limited sensitivity for open globe injury. Surgical exploration remains necessary when clinical suspicion persists despite inconclusive imaging.

开放球损伤是一种外科急诊，需要及时诊断以减少发病率。眶部CT经常在创伤情况下进行，对全球评估至关重要，特别是当床边评估有限时。本研究的主要目的是评估CT整体成像检测开放性球损伤的诊断准确性。次要目的是评估CT影像征象的诊断准确性。方法前瞻性注册一项系统评价方案（PROSPERO CRD42025638703）。2025年1月16日，检索Embase、Pubmed、Scopus和谷歌Scholar，没有日期限制。诊断准确性荟萃分析对开放球损伤的整体CT印象和个体CT成像征象进行分析。使用诊断准确性研究质量评估-2工具评估偏倚风险。结果8项研究符合纳入标准，共有827例患者，830例损伤球，339例确认开放球损伤。CT总体印象的敏感性和特异性分别为75% （95% CI, 0.69-0.79）和94% （95% CI, 0.91-0.96）。在个体体征中，眼球轮廓改变或巩膜不规则具有最高的诊断优势比（109;95% CI, 17-718），敏感性和特异性分别为71% （95% CI, 0.61-0.79）和98% （95% CI, 0.86-1.00）。前房深度改变、玻璃体出血、晶状体异常和眼内空气不敏感，但具有高度特异性。结论CT总体印象和个别影像学征象对开放性球损伤具有较高的特异性，但敏感性有限。当临床怀疑持续存在而影像学不确定时，手术探查仍然是必要的。

{"title":"Diagnostic test accuracy of CT for open globe injury: A systematic review and meta-analysis of overall impression and individual imaging signs","authors":"Mahmoud Omar , Nailah Ghouse , Alexander Azar , Sarah Atta , Wassim Malak","doi":"10.1016/j.injury.2026.113041","DOIUrl":"10.1016/j.injury.2026.113041","url":null,"abstract":"<div><h3>Introduction</h3><div>Open globe injury is a surgical emergency requiring prompt diagnosis to minimize morbidity. Orbital CT is frequently performed in trauma settings and is crucial for globe evaluation, particularly when bedside assessment is limited.</div><div>The primary objective was to evaluate the diagnostic accuracy of overall CT impression for detecting open globe injury. The secondary objective was to assess the diagnostic accuracy of CT imaging signs.</div></div><div><h3>Methods</h3><div>A systematic review protocol was prospectively registered (PROSPERO CRD42025638703). On January 16, 2025, Embase, Pubmed, Scopus, and Google Scholar were searched without date restrictions. Diagnostic accuracy meta-analyses were performed on overall CT impression and individual CT imaging signs for open globe injury. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.</div></div><div><h3>Results</h3><div>Eight studies met inclusion criteria representing 827 patients, 830 injured globes, and 339 confirmed open globe injury. The pooled sensitivity and specificity of overall CT impression was 75% (95% CI, 0.69–0.79) and 94% (95% CI, 0.91–0.96), respectively. Among individual signs, change in globe contour or scleral irregularity had the highest diagnostic odds ratio (109; 95% CI, 17–718) with sensitivity and specificity of 71% (95% CI, 0.61–0.79) and 98% (95% CI, 0.86–1.00), respectively. Change in anterior chamber depth, vitreous hemorrhage, lens abnormality, and intraocular air were insensitive but highly specific signs.</div></div><div><h3>Conclusions</h3><div>Overall CT impression and individual imaging signs demonstrate high specificity but limited sensitivity for open globe injury. Surgical exploration remains necessary when clinical suspicion persists despite inconclusive imaging.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113041"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950137","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}

引用次数: 0