Pub Date : 2025-02-01DOI: 10.1016/j.injury.2024.112072
Alexander Wilton, Ayman Sorial, Tanzeelah Jamadar, Martyn Parker
Aims
An increasing number of patients with hip fracture are taking oral anticoagulation medication including direct oral anticoagulants (DOAC). The management of these patients regarding the timing of surgery and occurrence of complications remains contentious. The aim of this study was to compare treatment and outcomes for hip fracture patients taking anticoagulation.
Methods
Data from a consecutive series of 3,707 hip fracture patients admitted to a single centre was collected over a seven-year period.
Results
The proportion of patients taking warfarin fell slightly over the study period (6.1 % to 4.7 %) whilst the proportion taking DOAC increased greatly (1.4 % to 11.4 %). Patients on oral anticoagulation were slight older (mean age 83 years for warfarin, 85 years for DOAC versus 80 years for those not on anticoagulation), more likely to have atrial fibrillation, less likely to take anti-platelet medication and less likely to have spinal anaesthesia. Patients taking oral anticoagulant had an increased delay to theatre (mean hours admission to theatre 37.9 for warfarin, 39.5 for DOAC, 31.1 for no anticoagulation). There was no difference in the number of patients transfused, wound complications, post-operative haemoglobin or 30 -day mortality between groups.
Conclusion
Current policies on the timing of surgery and anticoagulation are safe.
{"title":"Treatment and outcome after hip fracture for patients on oral anticoagulation","authors":"Alexander Wilton, Ayman Sorial, Tanzeelah Jamadar, Martyn Parker","doi":"10.1016/j.injury.2024.112072","DOIUrl":"10.1016/j.injury.2024.112072","url":null,"abstract":"<div><h3>Aims</h3><div>An increasing number of patients with hip fracture are taking oral anticoagulation medication including direct oral anticoagulants (DOAC). The management of these patients regarding the timing of surgery and occurrence of complications remains contentious. The aim of this study was to compare treatment and outcomes for hip fracture patients taking anticoagulation.</div></div><div><h3>Methods</h3><div>Data from a consecutive series of 3,707 hip fracture patients admitted to a single centre was collected over a seven-year period.</div></div><div><h3>Results</h3><div>The proportion of patients taking warfarin fell slightly over the study period (6.1 % to 4.7 %) whilst the proportion taking DOAC increased greatly (1.4 % to 11.4 %). Patients on oral anticoagulation were slight older (mean age 83 years for warfarin, 85 years for DOAC versus 80 years for those not on anticoagulation), more likely to have atrial fibrillation, less likely to take anti-platelet medication and less likely to have spinal anaesthesia. Patients taking oral anticoagulant had an increased delay to theatre (mean hours admission to theatre 37.9 for warfarin, 39.5 for DOAC, 31.1 for no anticoagulation). There was no difference in the number of patients transfused, wound complications, post-operative haemoglobin or 30 -day mortality between groups.</div></div><div><h3>Conclusion</h3><div>Current policies on the timing of surgery and anticoagulation are safe.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112072"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792677","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 : 2025-02-01DOI: 10.1016/j.injury.2024.112069
Jun Liu , Zhi Hui Liu , Ruo Nan Lu
Purpose
One of the primary causes of heat-induced compartment syndrome is the loss of elasticity of the body surface eschar itself, we have recently replaced escharotomy with conservative tangential excision in the treatment of compartment syndrome caused by heat and achieved good results.
Methods
Since 2019, our burn center has applied conservative tangential excision and heterogeneous dermal coverage technology for decompression treatment of 16 patients with thermal-induced compartment syndrome, involving 19 parts of the limbs and 5 parts of the chest and abdomen. All cases were treated with decompression under general anesthesia within 12–48 h after burn.
Results
All patients were treated with conservative tangential excision for decompression. After limb decompression, the peripheral blood supply was restored, and the obvious pulse could be touched. No further fasciotomy was performed, and no secondary damage of deep muscle, nerve and vascular tissue was found in the follow-up treatment; After thoracic and abdominal decompression, there was no respiratory restriction and circulatory disorder.
Conclusion
Conservative tangential excision represents an effective method for both the prevention and treatment of heat-induced compartment syndrome, it can be used as an alternative method for escharotomy.
{"title":"Conservative tangential excision instead of escharotomy in the treatment of compartment syndrome","authors":"Jun Liu , Zhi Hui Liu , Ruo Nan Lu","doi":"10.1016/j.injury.2024.112069","DOIUrl":"10.1016/j.injury.2024.112069","url":null,"abstract":"<div><h3>Purpose</h3><div>One of the primary causes of heat-induced compartment syndrome is the loss of elasticity of the body surface eschar itself, we have recently replaced escharotomy with conservative tangential excision in the treatment of compartment syndrome caused by heat and achieved good results.</div></div><div><h3>Methods</h3><div>Since 2019, our burn center has applied conservative tangential excision and heterogeneous dermal coverage technology for decompression treatment of 16 patients with thermal-induced compartment syndrome, involving 19 parts of the limbs and 5 parts of the chest and abdomen. All cases were treated with decompression under general anesthesia within 12–48 h after burn.</div></div><div><h3>Results</h3><div>All patients were treated with conservative tangential excision for decompression. After limb decompression, the peripheral blood supply was restored, and the obvious pulse could be touched. No further fasciotomy was performed, and no secondary damage of deep muscle, nerve and vascular tissue was found in the follow-up treatment; After thoracic and abdominal decompression, there was no respiratory restriction and circulatory disorder.</div></div><div><h3>Conclusion</h3><div>Conservative tangential excision represents an effective method for both the prevention and treatment of heat-induced compartment syndrome, it can be used as an alternative method for escharotomy.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112069"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815303","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 : 2025-02-01DOI: 10.1016/j.injury.2024.112068
Rui Li , Dapeng Li , Zhongqing Su , Zhigang Li , Huiqing Lan , Chunyu Bai , Xulong Xi , Xiaocheng Li
Introduction
Traumatic brain injury (TBI) is a prevalent type of disabling and fatal injury in infants/toddlers, which is usually caused by falls or traffic accidents. Considering that it is difficult to collect realistic material properties and validation data of child heads due to ethical reasons, experiments on the piglet heads and the finite element (FE) models are generally used as a substitute for the investigations of child TBI.
Methods
In this study, first, a high-quality FE model of a 4-week-old piglet head, including brain (cerebrum, cerebellum, brainstem), skull, soft tissue, cerebrospinal fluid, dura matter, pia matter and mandible, is developed. Then, test for the material properties of the piglet head and that for the global validation data are conducted. For the former, the mechanical properties of the brain, overlying soft tissue and skull of the 4-week-old piglet head are tested, and the constitutive models and corresponding parameters are further defined. For the latter, the quasi-static compression test and dynamic impact test (free-fall drop impact test, drop-hammer impact test) are performed on the piglet head. Finally, the piglet head FE model was validated against tests in terms of the contact force and intracranial pressure (ICP) under eight conditions (one for the compression condition, four for the free-fall impact condition, and three for the drop-hammer impact condition).
Results
The trends of simulated curves are consistent with the experimental results under all conditions. For the contact force, the average error of the peak values between simulations and tests is about 12.9 %, and the average error of time durations is about 6.8 %. For the ICP, the average errors of peak values and time durations between simulations and tests are about 8.9 % and 9.9 %.
Conclusions
The results show that the piglet head model has high bio-fidelity, which can be used to predict the head global response and the ICP, and further to assist the investigation of child TBI. The model provides another effective way to evaluate the modeling strategies and material constitute models suitable for child head FE model, and can better to understand the inducement and mechanism of child TBI under different external loading conditions.
{"title":"Modeling, experiment, and validation of a piglet head","authors":"Rui Li , Dapeng Li , Zhongqing Su , Zhigang Li , Huiqing Lan , Chunyu Bai , Xulong Xi , Xiaocheng Li","doi":"10.1016/j.injury.2024.112068","DOIUrl":"10.1016/j.injury.2024.112068","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injury (TBI) is a prevalent type of disabling and fatal injury in infants/toddlers, which is usually caused by falls or traffic accidents. Considering that it is difficult to collect realistic material properties and validation data of child heads due to ethical reasons, experiments on the piglet heads and the finite element (FE) models are generally used as a substitute for the investigations of child TBI.</div></div><div><h3>Methods</h3><div>In this study, first, a high-quality FE model of a 4-week-old piglet head, including brain (cerebrum, cerebellum, brainstem), skull, soft tissue, cerebrospinal fluid, dura matter, pia matter and mandible, is developed. Then, test for the material properties of the piglet head and that for the global validation data are conducted. For the former, the mechanical properties of the brain, overlying soft tissue and skull of the 4-week-old piglet head are tested, and the constitutive models and corresponding parameters are further defined. For the latter, the quasi-static compression test and dynamic impact test (free-fall drop impact test, drop-hammer impact test) are performed on the piglet head. Finally, the piglet head FE model was validated against tests in terms of the contact force and intracranial pressure (ICP) under eight conditions (one for the compression condition, four for the free-fall impact condition, and three for the drop-hammer impact condition).</div></div><div><h3>Results</h3><div>The trends of simulated curves are consistent with the experimental results under all conditions. For the contact force, the average error of the peak values between simulations and tests is about 12.9 %, and the average error of time durations is about 6.8 %. For the ICP, the average errors of peak values and time durations between simulations and tests are about 8.9 % and 9.9 %.</div></div><div><h3>Conclusions</h3><div>The results show that the piglet head model has high bio-fidelity, which can be used to predict the head global response and the ICP, and further to assist the investigation of child TBI. The model provides another effective way to evaluate the modeling strategies and material constitute models suitable for child head FE model, and can better to understand the inducement and mechanism of child TBI under different external loading conditions.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112068"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787004","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 : 2025-02-01DOI: 10.1016/j.injury.2024.112040
Shayan Rakhit , Areg Grigorian , Erika L Rivera , Francisco A Alvarado , Mayur B Patel , Amelia W Maiga
Background
Prior research suggests that plasma may improve outcomes in traumatic brain injury (TBI). We examined the association between plasma administration and mortality in moderate-severe TBI in a large retrospective cohort, hypothesizing plasma is associated with decreased mortality after accounting for confounding covariates.
Materials and Methods
Patients from the 2017–2020 Trauma Quality Improvement Program (TQIP) dataset ≥18 years with moderate-severe TBI were included. We excluded patients with comorbidities associated with bleeding or sensitivity to volume (antiplatelet or anticoagulation medications, bleeding disorders, cirrhosis, congestive heart failure, chronic obstructive pulmonary disease). Multivariable logistic regression examined the association between plasma volume transfused in the first four hours and hospital mortality, adjusting for sociodemographics, severity of injury/illness, neurologic status, and volume of other blood products. We also adjusted for and included interactions with hemorrhage markers (shock; need for hemorrhage control).
Results
Of 63,918 patients included, hospital mortality was 37.0 %. 82.8 % received no plasma. Each unit of plasma was associated with greater unadjusted mortality, with odds ratio (OR): 1.13 (95 % confidence interval: 1.12–1.14), but after confounder adjustment, plasma units were not associated with greater mortality, with OR: 1.01 (0.99–1.03). While the overall adjusted effect of plasma was not significant, significant interactions between hemorrhage markers and plasma were present (p < 0.001).
Conclusions
Administration of plasma within the first four hours after hospital presentation was not associated with decreased or increased mortality in adult patients with moderate to severe TBI after confounder adjustment. Interaction analysis suggests the presence of hemorrhage improves the effect of plasma on mortality in TBI. This important clinical question should be answered with a prospective randomized study of plasma for nonbleeding patients with TBI.
{"title":"Plasma transfusion and hospital mortality in moderate-severe traumatic brain injury","authors":"Shayan Rakhit , Areg Grigorian , Erika L Rivera , Francisco A Alvarado , Mayur B Patel , Amelia W Maiga","doi":"10.1016/j.injury.2024.112040","DOIUrl":"10.1016/j.injury.2024.112040","url":null,"abstract":"<div><h3>Background</h3><div>Prior research suggests that plasma may improve outcomes in traumatic brain injury (TBI). We examined the association between plasma administration and mortality in moderate-severe TBI in a large retrospective cohort, hypothesizing plasma is associated with decreased mortality after accounting for confounding covariates.</div></div><div><h3>Materials and Methods</h3><div>Patients from the 2017–2020 Trauma Quality Improvement Program (TQIP) dataset ≥18 years with moderate-severe TBI were included. We excluded patients with comorbidities associated with bleeding or sensitivity to volume (antiplatelet or anticoagulation medications, bleeding disorders, cirrhosis, congestive heart failure, chronic obstructive pulmonary disease). Multivariable logistic regression examined the association between plasma volume transfused in the first four hours and hospital mortality, adjusting for sociodemographics, severity of injury/illness, neurologic status, and volume of other blood products. We also adjusted for and included interactions with hemorrhage markers (shock; need for hemorrhage control).</div></div><div><h3>Results</h3><div>Of 63,918 patients included, hospital mortality was 37.0 %. 82.8 % received no plasma. Each unit of plasma was associated with greater unadjusted mortality, with odds ratio (OR): 1.13 (95 % confidence interval: 1.12–1.14), but after confounder adjustment, plasma units were not associated with greater mortality, with OR: 1.01 (0.99–1.03). While the overall adjusted effect of plasma was not significant, significant interactions between hemorrhage markers and plasma were present (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Administration of plasma within the first four hours after hospital presentation was not associated with decreased or increased mortality in adult patients with moderate to severe TBI after confounder adjustment. Interaction analysis suggests the presence of hemorrhage improves the effect of plasma on mortality in TBI. This important clinical question should be answered with a prospective randomized study of plasma for nonbleeding patients with TBI.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112040"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901170","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 : 2025-02-01DOI: 10.1016/j.injury.2024.112090
Ellie Grant , Alan Bowman , Louise Johnson
Background
Traumatic injury poses significant physical and psychological challenges, often resulting in psychological distress, encompassing symptoms of anxiety, depression and post-traumatic stress. Despite the recognised need for psychological care in trauma rehabilitation, there is limited empirical evidence of effective interventions tailored specifically for individuals with traumatic injuries, leading to a practice-evidence gap.
Objectives
This review aimed to evaluate the effectiveness of psychological and behavioural interventions for reducing psychological distress in adults following traumatic injury.
Methods
This systematic review followed a published protocol (CRD4202342946) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Synthesis Without Meta-analysis (SWiM) in systematic reviews reporting items. Peer-reviewed studies were identified through searches of MEDLINE, APA PsycInfo, CINAHL and Embase databases. Eligible studies involved adults aged 18 and older who had experienced physical trauma requiring immediate medical attention. Studies involving participants with neurological injuries and/or military personnel were not included. Both English- and non-English-language articles were considered. Effect direction was employed as the method of synthesis and risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC 9) nine-item assessment tool.
Results
A total of six studies met the review eligibility criteria. There was considerable heterogeneity across the interventions in terms of their nature, timing and duration, however all interventions were delivered within 3-months post-injury. Most studies reported positive intervention effects, with no adverse effects reported. Cognitive Behavioural Therapy (CBT) was the most reported intervention across the studies.
Conclusions
The review findings highlight the preliminary evidence supporting CBT as a viable option for reducing psychological distress following traumatic injury. However, this may be explained by the dominance of CBT in the literature due to its structured nature, availability and suitability for research, potentially limiting the visibility of alternative therapeutic approaches. Further, these findings are constrained by study limitations, including small sample sizes, heterogeneity of injury types and severity, reliance on self-reported outcomes, and limited follow-up data. Future research should aim to include longitudinal follow-up assessments and explore alternative therapeutic approaches to contribute to our understanding of meaningful trauma rehabilitation methods.
{"title":"Effectiveness of interventions for psychological distress following traumatic injury: A systematic review","authors":"Ellie Grant , Alan Bowman , Louise Johnson","doi":"10.1016/j.injury.2024.112090","DOIUrl":"10.1016/j.injury.2024.112090","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic injury poses significant physical and psychological challenges, often resulting in psychological distress, encompassing symptoms of anxiety, depression and post-traumatic stress. Despite the recognised need for psychological care in trauma rehabilitation, there is limited empirical evidence of effective interventions tailored specifically for individuals with traumatic injuries, leading to a practice-evidence gap.</div></div><div><h3>Objectives</h3><div>This review aimed to evaluate the effectiveness of psychological and behavioural interventions for reducing psychological distress in adults following traumatic injury.</div></div><div><h3>Methods</h3><div>This systematic review followed a published protocol (CRD4202342946) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Synthesis Without Meta-analysis (SWiM) in systematic reviews reporting items. Peer-reviewed studies were identified through searches of MEDLINE, APA PsycInfo, CINAHL and Embase databases. Eligible studies involved adults aged 18 and older who had experienced physical trauma requiring immediate medical attention. Studies involving participants with neurological injuries and/or military personnel were not included. Both English- and non-English-language articles were considered. Effect direction was employed as the method of synthesis and risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC 9) nine-item assessment tool.</div></div><div><h3>Results</h3><div>A total of six studies met the review eligibility criteria. There was considerable heterogeneity across the interventions in terms of their nature, timing and duration, however all interventions were delivered within 3-months post-injury. Most studies reported positive intervention effects, with no adverse effects reported. Cognitive Behavioural Therapy (CBT) was the most reported intervention across the studies.</div></div><div><h3>Conclusions</h3><div>The review findings highlight the preliminary evidence supporting CBT as a viable option for reducing psychological distress following traumatic injury. However, this may be explained by the dominance of CBT in the literature due to its structured nature, availability and suitability for research, potentially limiting the visibility of alternative therapeutic approaches. Further, these findings are constrained by study limitations, including small sample sizes, heterogeneity of injury types and severity, reliance on self-reported outcomes, and limited follow-up data. Future research should aim to include longitudinal follow-up assessments and explore alternative therapeutic approaches to contribute to our understanding of meaningful trauma rehabilitation methods.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112090"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928909","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 : 2025-02-01DOI: 10.1016/j.injury.2025.112150
Hasan Hüseyin Çam , Fadime Ustuner Top
Introduction
Injuries and violence are among the most prominent public health problems in the world. As well as being a leading cause of mortality – particularly among children and young adults – many of the millions of non-fatal injuries result in life-long disabilities and health consequences. The aim of this study was to estimate the prevalence of unintentional injuries and violence, and their associated factors among high school students.
Methods
This cross-sectional study included a total of 1218 high-school students in Turkey. Data were collected through a facilitated self-administered questionnaire with questions adapted from the Global School-based Student Health Survey instrument. Data were analyzed in IBM SPSS Statistics 28.0 using chi-square test to find statistical significance if any. The significant variables from the chi-square test were selected for multiple logistic regression analysis.
Results
The overall prevalence of physical attack, physical fighting, and serious injuries were 8.3 %, 14.8 %, and 11.7 %, respectively. In a multiple regression analysis, student truancy and lateness, worry, suicide attempts, and not having close friends were found to be associated with physically attacked, physical fight, and serious injuries.
Conclusion
This study demonstrated that the prevalence of unintentional injuries and violence among high school students is a major public health problem in Turkey. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions.
{"title":"Prevalence and determinants of unintentional injuries and violence among high school students in Turkey: A cross-sectional study","authors":"Hasan Hüseyin Çam , Fadime Ustuner Top","doi":"10.1016/j.injury.2025.112150","DOIUrl":"10.1016/j.injury.2025.112150","url":null,"abstract":"<div><h3>Introduction</h3><div>Injuries and violence are among the most prominent public health problems in the world. As well as being a leading cause of mortality – particularly among children and young adults – many of the millions of non-fatal injuries result in life-long disabilities and health consequences. The aim of this study was to estimate the prevalence of unintentional injuries and violence, and their associated factors among high school students.</div></div><div><h3>Methods</h3><div>This cross-sectional study included a total of 1218 high-school students in Turkey. Data were collected through a facilitated self-administered questionnaire with questions adapted from the Global School-based Student Health Survey instrument. Data were analyzed in IBM SPSS Statistics 28.0 using chi-square test to find statistical significance if any. The significant variables from the chi-square test were selected for multiple logistic regression analysis.</div></div><div><h3>Results</h3><div>The overall prevalence of physical attack, physical fighting, and serious injuries were 8.3 %, 14.8 %, and 11.7 %, respectively. In a multiple regression analysis, student truancy and lateness, worry, suicide attempts, and not having close friends were found to be associated with physically attacked, physical fight, and serious injuries.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the prevalence of unintentional injuries and violence among high school students is a major public health problem in Turkey. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112150"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980986","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 : 2025-02-01DOI: 10.1016/j.injury.2024.112139
Ezequiel Fernando Martínez , Fernando Holc , Pedro Bronenberg Victorica , Gerardo Luis Gallucci , Mariano Oscar Abrego , Pablo De Carli , Pablo Daniel Roitman , Jorge Guillermo Boretto
Introduction
During revision surgery for the management of patients presenting with long-bone upper extremity nonunion, it is crucial to rule out fracture-related infection (FRI). This is especially true if there are clinical signs suggestive of FRI, or if there is a history of prior FRI, open wound fracture, or surgery. This study aimed to determine the efficacy of frozen section analysis (FSA) in providing real-time diagnosis of FRI in patients with upper-limb long-bone nonunion undergoing revision surgery.
Patients and Methods
We included previously surgically treated patients who underwent revision surgery for chronic/late-onset nonunion of the long bones of the upper limbs over a 9-year period. We retrospectively applied the FRI criteria to identify eligible patients and recorded their clinical features and demographic characteristics. In all included patients, samples for microbiological analysis and FSA were collected simultaneously during revision surgery. Patients were categorized according to intraoperative culture results as having aseptic or infected nonunion. The sensitivity, specificity, positive and negative predictive values, and accuracy of FSA test were calculated and compared using microbiological analysis as the reference standard test. The concordance rate between FSA and definitive histopathology was also determined.
Results
Sixty-two patients who were surgically treated for nonunion of the arm or forearm were included in this study. Septic nonunion was diagnosed intraoperatively in 9 patients based on FSA findings, while microbiological analysis confirmed septic nonunion in 8 patients. The sensitivity and specificity of FSA were 88 % (95 % confidence interval [CI] [47, 100]) and 96 % (95 % CI [87, 100]), respectively. Positive and negative predictive values were 78 % (95 % CI [47, 93]) and 98 % (95 % CI [89, 100]), respectively, with an overall test accuracy of 95 % (95 % CI [87, 99]). Cohen's Kappa coefficient between FSA and definitive histopathology was 0.74 (95 % CI [0.5, 1]).
Conclusions
FSA showed high sensitivity and specificity for the detection of active infection during revision surgery for nonunion of the upper limb. Owing to its high negative predictive value, it can reliably rule out active infections during revision surgery. Since the results are obtained immediately during revision surgery, this approach offers the significant advantage of enabling real-time decision-making.
{"title":"Intraoperative frozen section analysis for detection of fracture-related infection in nonunion of the upper limb. Diagnostic accuracy study","authors":"Ezequiel Fernando Martínez , Fernando Holc , Pedro Bronenberg Victorica , Gerardo Luis Gallucci , Mariano Oscar Abrego , Pablo De Carli , Pablo Daniel Roitman , Jorge Guillermo Boretto","doi":"10.1016/j.injury.2024.112139","DOIUrl":"10.1016/j.injury.2024.112139","url":null,"abstract":"<div><h3>Introduction</h3><div>During revision surgery for the management of patients presenting with long-bone upper extremity nonunion, it is crucial to rule out fracture-related infection (FRI). This is especially true if there are clinical signs suggestive of FRI, or if there is a history of prior FRI, open wound fracture, or surgery. This study aimed to determine the efficacy of frozen section analysis (FSA) in providing real-time diagnosis of FRI in patients with upper-limb long-bone nonunion undergoing revision surgery.</div></div><div><h3>Patients and Methods</h3><div>We included previously surgically treated patients who underwent revision surgery for chronic/late-onset nonunion of the long bones of the upper limbs over a 9-year period. We retrospectively applied the FRI criteria to identify eligible patients and recorded their clinical features and demographic characteristics. In all included patients, samples for microbiological analysis and FSA were collected simultaneously during revision surgery. Patients were categorized according to intraoperative culture results as having aseptic or infected nonunion. The sensitivity, specificity, positive and negative predictive values, and accuracy of FSA test were calculated and compared using microbiological analysis as the reference standard test. The concordance rate between FSA and definitive histopathology was also determined.</div></div><div><h3>Results</h3><div>Sixty-two patients who were surgically treated for nonunion of the arm or forearm were included in this study. Septic nonunion was diagnosed intraoperatively in 9 patients based on FSA findings, while microbiological analysis confirmed septic nonunion in 8 patients. The sensitivity and specificity of FSA were 88 % (95 % confidence interval [CI] [47, 100]) and 96 % (95 % CI [87, 100]), respectively. Positive and negative predictive values were 78 % (95 % CI [47, 93]) and 98 % (95 % CI [89, 100]), respectively, with an overall test accuracy of 95 % (95 % CI [87, 99]). Cohen's Kappa coefficient between FSA and definitive histopathology was 0.74 (95 % CI [0.5, 1]).</div></div><div><h3>Conclusions</h3><div>FSA showed high sensitivity and specificity for the detection of active infection during revision surgery for nonunion of the upper limb. Owing to its high negative predictive value, it can reliably rule out active infections during revision surgery. Since the results are obtained immediately during revision surgery, this approach offers the significant advantage of enabling real-time decision-making.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112139"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985527","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 : 2025-02-01DOI: 10.1016/j.injury.2024.112050
Zachary A. Mohs , Nathaniel Albrecht , Anthony J. Duncan , Li Cao , Mentor Ahmeti
Introduction
Pelvic fractures (PF) occur in up to 9 % of trauma cases, primarily from high-impact events, and are associated with increased morbidity and mortality due to frequent concomitant injuries. Thoracolumbar (TL) spinal fractures, particularly at the T10-L2 junction, are also common in high-energy trauma but are less frequently examined in association with PF. Missed TL fractures can lead to serious neurological deficits. Although Advanced Trauma Life Support (ATLS) recommends screening for TL fractures in trauma patients, no standardized guidelines exist. This study aims to explore the relationship between PF and TL fractures in trauma patients and to identify key variables associated with these injuries.
Methods
This retrospective cohort study analyzed data from the 2021 National Trauma Data Bank (NTDB), focusing on patients with PF resulting from high-impact blunt trauma. Patients were identified using ICD-9 codes for pelvic fractures, and those under 18 years of age or with penetrating trauma were excluded. We collected demographic data, injury grading (Injury Severity Score [ISS], Abbreviated Injury Scale [AIS]), and patient outcomes, comparing those with isolated pelvic fractures (IPF) to those with concomitant pelvic and TL fractures (PTLF).
Results
Of the 37,987 patients with PF, 32.4 % (n = 12,318) had concomitant TL fractures. PTLF patients were older (mean age 44.12 vs. 40.12 years, p < 0.001) and exhibited higher ISS and AIS scores compared to IPF patients. The PTLF group had longer hospital stays (14.51 days vs. 9.4 days, p < 0.001) and higher rates of ICU admission (41.4 % vs. 24.0 %, p < 0.001) and mortality (9.5 % vs. 4.3 %, p < 0.001). PTLF patients were less likely to be discharged home (29.5 % vs. 43.5 %, p < 0.001) and more likely to be transferred to rehabilitation or long-term care facilities. Motor vehicle collisions were the most common mechanism of injury, but auto-pedestrian accidents were more frequent in the PTLF group (17.3 % vs. 11.1 %, p < 0.001). Lumbar spine fractures accounted for 70.2 % of TL injuries.
Conclusion
Pelvic fractures from high-impact trauma are strongly associated with concomitant TL fractures, which lead to worse clinical outcomes. Routine TL spine screening in these patients is recommended to ensure timely diagnosis and treatment
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Pub Date : 2025-02-01DOI: 10.1016/j.injury.2025.112143
Armarion Stegall, J. Tracy Watson, Heidi Israel
Introduction
In the United States, deep vein thrombosis (DVT) and pulmonary embolism (PE) ranked high in terms of possibly preventable hospital deaths. Victims of trauma were at a higher risk of developing thromboembolic complications, and thus various agents were used for prophylaxis. Multiple studies recommended holding these agents in the perioperative period to decrease the potential complications of additional bleeding, wound issues, hematoma etc. However, the data regarding the timing and duration of withholding these agents was not consistent and at times surgeon specific. The aim of this study was to compare the incidence of DVT/PE in trauma patients before and after a June 2022 policy intervention to operate through prophylactic anticoagulation at an academic trauma center.
Methods
We compared DVT/PE rates in trauma patients requiring surgery prior to and following policy change at our institution. The query included charts from January 1, 2018, through December 31, 2023. Clinical information relating to trauma date, surgery date, injury type, anticoagulant administration, DVT/PE development, and death, if applicable, was obtained from patient charts. We conducted a chi-square post hoc analysis to evaluate the incidence of DVT or PE before and after a policy change. The analysis focused on two categories: the presence or absence of DVT/PE.
Results
DVT/PE development was 14.553 times more likely pre-policy change when anticoagulation was held prior to surgery compared to post-policy change when anticoagulation was administered before surgery (X2 (3, N = 374) =14.553, p=.002). Mortality related to DVT/PE showed no significant difference between pre-policy and post-policy groups (X2 (1, N = 374) = 0.130, p = .718). After excluding patients over age 65, analysis of MVA blunt trauma charts showed no statistical difference in blood transfusions pre policy v. post policy (X2 (1, N = 174) = 0.2198, p = .639).
Conclusion
Findings suggested that DVT/PE rates have significantly decreased post policy change without a significant increase in mortality and bleeding risk.
在美国，深静脉血栓形成（DVT）和肺栓塞（PE）在可能预防的医院死亡中排名靠前。创伤患者发生血栓栓塞并发症的风险较高，因此使用各种药物进行预防。多项研究建议在围手术期使用这些药物，以减少额外出血、伤口问题、血肿等潜在并发症。然而，关于保留这些药物的时间和持续时间的数据是不一致的，有时是针对外科医生的。本研究的目的是比较2022年6月在学术创伤中心通过预防性抗凝手术进行政策干预前后创伤患者DVT/PE的发生率。方法：我们比较了我院政策改变前后需要手术的创伤患者的DVT/PE率。该查询包括从2018年1月1日到2023年12月31日的图表。从患者图表中获得与创伤日期、手术日期、损伤类型、抗凝剂给药、DVT/PE发展和死亡（如果适用）相关的临床信息。我们进行了卡方事后分析来评估政策改变前后DVT或PE的发生率。分析集中在两类：有无DVT/PE。结果：术前抗凝治疗后DVT/PE发生改变的可能性是术前抗凝治疗后政策改变的14.553倍（X2 (3, N = 374) =14.553, p= 0.002）。手术前后DVT/PE相关死亡率差异无统计学意义（X2 (1, N = 374) = 0.130, p = .718）。在排除65岁以上患者后，对MVA钝性创伤图表进行分析，结果显示政策前与政策后输血量无统计学差异（X2 (1, N = 174) = 0.2198, p = 0.639）。结论：研究结果表明，政策改变后DVT/PE率显著降低，但死亡率和出血风险未显著增加。
{"title":"Assessing the impact of perioperative anticoagulant continuation on DVT/PE rates in trauma patients","authors":"Armarion Stegall, J. Tracy Watson, Heidi Israel","doi":"10.1016/j.injury.2025.112143","DOIUrl":"10.1016/j.injury.2025.112143","url":null,"abstract":"<div><h3>Introduction</h3><div>In the United States, deep vein thrombosis (DVT) and pulmonary embolism (PE) ranked high in terms of possibly preventable hospital deaths. Victims of trauma were at a higher risk of developing thromboembolic complications, and thus various agents were used for prophylaxis. Multiple studies recommended holding these agents in the perioperative period to decrease the potential complications of additional bleeding, wound issues, hematoma etc. However, the data regarding the timing and duration of withholding these agents was not consistent and at times surgeon specific. The aim of this study was to compare the incidence of DVT/PE in trauma patients before and after a June 2022 policy intervention to operate through prophylactic anticoagulation at an academic trauma center.</div></div><div><h3>Methods</h3><div>We compared DVT/PE rates in trauma patients requiring surgery prior to and following policy change at our institution. The query included charts from January 1, 2018, through December 31, 2023. Clinical information relating to trauma date, surgery date, injury type, anticoagulant administration, DVT/PE development, and death, if applicable, was obtained from patient charts. We conducted a chi-square post hoc analysis to evaluate the incidence of DVT or PE before and after a policy change. The analysis focused on two categories: the presence or absence of DVT/PE.</div></div><div><h3>Results</h3><div>DVT/PE development was 14.553 times more likely pre-policy change when anticoagulation was held prior to surgery compared to post-policy change when anticoagulation was administered before surgery (X<sup>2</sup> (3, N = 374) =14.553, <em>p</em>=.002). Mortality related to DVT/PE showed no significant difference between pre-policy and post-policy groups (X<sup>2</sup> (1, N = 374) = 0.130, <em>p</em> = .718). After excluding patients over age 65, analysis of MVA blunt trauma charts showed no statistical difference in blood transfusions pre policy v. post policy (X<sup>2</sup> (1, N = 174) = 0.2198, <em>p</em> = .639).</div></div><div><h3>Conclusion</h3><div>Findings suggested that DVT/PE rates have significantly decreased post policy change without a significant increase in mortality and bleeding risk.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112143"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974050","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 : 2025-02-01DOI: 10.1016/j.injury.2024.112137
Katharina Trenkwalder , Sandra Erichsen , Ferdinand Weisemann , Christian von Rüden , Peter Augat , SAND Research Group , Simon Hackl
<div><div>Treatment algorithms for fracture nonunion depend on the presence or absence of bacterial infection. However, it is often impossible to identify infection preoperatively. While some infections may present with clinical signs of infection, low-grade infections lack infection signs and have a clinical presentation similar to aseptic nonunion. The clinical relevance of low-grade infection in nonunion is not entirely clear. Therefore, the aim of this study was to evaluate the role of low-grade infection in the development and management of lower extremity nonunion.</div><div>A prospective multicenter clinical study enrolled patients with femoral or tibial shaft nonunion and regular healed fractures, scheduled for nonunion revision and routine implant removal, respectively. Preoperatively, serum markers including C-reactive protein (CRP), leukocytes, and procalcitonin were determined, clinical infection signs were recorded, and a suspected septic or aseptic diagnosis was made prior to surgery and further diagnostics. Tissue samples were collected for microbiology and histopathology, and osteosynthesis material for sonication. Nonunion patients were followed for twelve months, during which the definitive diagnosis of “septic” or “aseptic” nonunion was made according to diagnostic criteria for fracture-related infection.</div><div>One hundred and ten patients with nonunion and 34 patients with regular healed fractures were included. Sixty-two nonunion patients were diagnosed as aseptic, 22 with expected and confirmed infection, and 23 with unexpected low-grade infection. Three patients had an unclear diagnosis. Low-grade infection was detected in 28 % of presumed aseptic nonunion patients. Sensitivity and specificity for the suspected diagnosis were 49 % and 95 %, respectively. The suspected diagnosis had a significant impact on revision strategy. All medians of the preoperative blood values were within the reference ranges except for CRP, which was slightly elevated in the expected and confirmed infected nonunion group. Expected and confirmed septic nonunion and unexpected low-grade infected nonunion demonstrated a similar bacterial spectrum. While 10 % of patients with aseptic nonunion required follow-up surgeries, re-operation rates were higher in patients with low-grade infection and expected and confirmed infection at 30 % and 64 %, respectively. Patients with low-grade infections were treated less frequently with systemic antibiotics and for a shorter duration than patients with expected and confirmed infections, with no significant difference in healing rate which was 83 % in low-grade and 62 % in expected and confirmed infections. The healing rate of aseptic nonunion was 90 %. A limitation of this study is the limited number of tissue samples for microbiological and histopathological diagnostics in the suspected aseptic nonunion cohort, which may have led to an underestimation of the low-grade infection rate.</div><div>Our findings sug
{"title":"Low-grade infections in nonunion of the femur and tibia without clinical suspicion of infection – Incidence, microbiology, treatment, and outcome","authors":"Katharina Trenkwalder , Sandra Erichsen , Ferdinand Weisemann , Christian von Rüden , Peter Augat , SAND Research Group , Simon Hackl","doi":"10.1016/j.injury.2024.112137","DOIUrl":"10.1016/j.injury.2024.112137","url":null,"abstract":"<div><div>Treatment algorithms for fracture nonunion depend on the presence or absence of bacterial infection. However, it is often impossible to identify infection preoperatively. While some infections may present with clinical signs of infection, low-grade infections lack infection signs and have a clinical presentation similar to aseptic nonunion. The clinical relevance of low-grade infection in nonunion is not entirely clear. Therefore, the aim of this study was to evaluate the role of low-grade infection in the development and management of lower extremity nonunion.</div><div>A prospective multicenter clinical study enrolled patients with femoral or tibial shaft nonunion and regular healed fractures, scheduled for nonunion revision and routine implant removal, respectively. Preoperatively, serum markers including C-reactive protein (CRP), leukocytes, and procalcitonin were determined, clinical infection signs were recorded, and a suspected septic or aseptic diagnosis was made prior to surgery and further diagnostics. Tissue samples were collected for microbiology and histopathology, and osteosynthesis material for sonication. Nonunion patients were followed for twelve months, during which the definitive diagnosis of “septic” or “aseptic” nonunion was made according to diagnostic criteria for fracture-related infection.</div><div>One hundred and ten patients with nonunion and 34 patients with regular healed fractures were included. Sixty-two nonunion patients were diagnosed as aseptic, 22 with expected and confirmed infection, and 23 with unexpected low-grade infection. Three patients had an unclear diagnosis. Low-grade infection was detected in 28 % of presumed aseptic nonunion patients. Sensitivity and specificity for the suspected diagnosis were 49 % and 95 %, respectively. The suspected diagnosis had a significant impact on revision strategy. All medians of the preoperative blood values were within the reference ranges except for CRP, which was slightly elevated in the expected and confirmed infected nonunion group. Expected and confirmed septic nonunion and unexpected low-grade infected nonunion demonstrated a similar bacterial spectrum. While 10 % of patients with aseptic nonunion required follow-up surgeries, re-operation rates were higher in patients with low-grade infection and expected and confirmed infection at 30 % and 64 %, respectively. Patients with low-grade infections were treated less frequently with systemic antibiotics and for a shorter duration than patients with expected and confirmed infections, with no significant difference in healing rate which was 83 % in low-grade and 62 % in expected and confirmed infections. The healing rate of aseptic nonunion was 90 %. A limitation of this study is the limited number of tissue samples for microbiological and histopathological diagnostics in the suspected aseptic nonunion cohort, which may have led to an underestimation of the low-grade infection rate.</div><div>Our findings sug","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112137"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974051","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}
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