Pub Date : 2025-01-17DOI: 10.1016/j.injury.2025.112175
Gi Young Seo , Arpita Das , Silvia Manzanero , Keeyeon Kim , Carl Lisec , Michael Muller
Background
Indications for, and usage of, anticoagulant (AC) and antiplatelet (AP) agents is increasing. In this context, it is important to understand the evidence base of the effect of pre-injury AC/AP agents on patient outcomes in the context of traumatic solid organ injury (SOI) to inform management protocols.
Methods
A scoping review of the literature was undertaken with a systematic search strategy within the PubMed and Scopus databases. Study characteristics, clinical outcomes and outcome measures including mortality, hospital length of stay, admission to intensive care units, length of stay in intensive care and management details were extracted from included studies.
Results
The search identified six eligible studies reporting results from a total of 26,960 patients. Patients on AC/AP are more likely to fail non-operative management (NOM) than their non-AC/AP counterparts; at the same time, they are less likely to be operated on as a first line of management. Clinical outcome measures (mortality, length of stay, admission to intensive care units, and length of intensive care unit stay) were heterogeneous across studies, but it is likely that AC/AP patients have poorer outcomes in SOI. Results on transfusion requirements were inconclusive.
Conclusion
Few studies have examined the effect of pre-injury anticoagulation on outcomes in trauma patients sustaining solid organ injuries. Future studies should more closely examine solid organ trauma within the elderly group, as well as the effect of newer AC/AP agents in current use.
{"title":"The influence of pre-injury anticoagulant or antiplatelet agents on outcomes in trauma patients sustaining abdominal solid organ injuries: A scoping review","authors":"Gi Young Seo , Arpita Das , Silvia Manzanero , Keeyeon Kim , Carl Lisec , Michael Muller","doi":"10.1016/j.injury.2025.112175","DOIUrl":"10.1016/j.injury.2025.112175","url":null,"abstract":"<div><h3>Background</h3><div>Indications for, and usage of, anticoagulant (AC) and antiplatelet (AP) agents is increasing. In this context, it is important to understand the evidence base of the effect of pre-injury AC/AP agents on patient outcomes in the context of traumatic solid organ injury (SOI) to inform management protocols.</div></div><div><h3>Methods</h3><div>A scoping review of the literature was undertaken with a systematic search strategy within the PubMed and Scopus databases. Study characteristics, clinical outcomes and outcome measures including mortality, hospital length of stay, admission to intensive care units, length of stay in intensive care and management details were extracted from included studies.</div></div><div><h3>Results</h3><div>The search identified six eligible studies reporting results from a total of 26,960 patients. Patients on AC/AP are more likely to fail non-operative management (NOM) than their non-AC/AP counterparts; at the same time, they are less likely to be operated on as a first line of management. Clinical outcome measures (mortality, length of stay, admission to intensive care units, and length of intensive care unit stay) were heterogeneous across studies, but it is likely that AC/AP patients have poorer outcomes in SOI. Results on transfusion requirements were inconclusive.</div></div><div><h3>Conclusion</h3><div>Few studies have examined the effect of pre-injury anticoagulation on outcomes in trauma patients sustaining solid organ injuries. Future studies should more closely examine solid organ trauma within the elderly group, as well as the effect of newer AC/AP agents in current use.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112175"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026103","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 : 2025-01-17DOI: 10.1016/j.injury.2025.112162
Matthew Cao , David B. Doherty , Hongjia He , Vinay P. Vanodia , Kristin Reeves , Sabir K. Ismaily , Jonathan J. Sauer , Shuyang Han
Introduction
Clinical data on osseointegration (OI) for limb replacement indicates a concerning increase in mechanical complications after five years post-implantation. Since adequate bone-implant contact and proper implant alignment are critical factors for successful osseointegration, it is essential to identify the factors influencing these outcomes. This study aimed to assess the effects of residual femur length and implant sizing on bone-implant contact and implant alignment.
Methods
Three-dimensional models of eight cadaveric femora were reconstructed from CT scans, and transfemoral amputations were simulated for each femur at three levels: short (ST: 1/3 L), medium (MD: 1/2 L), and long (LG: 2/3 L). Virtual OI surgeries were then performed using computer-aided design (CAD) models, and implant sizes were recorded. Subsequently, the effect of implant sizing was assessed by adjusting the implant size by ±1 mm. Contact length and implant alignment were compared between the groups using repeated measures analysis of variance with Bonferroni correction.
Results
The contact in the ST group (65.2 ± 7.3 %) was significantly less compared to the MD (96.1 ± 4.1 %, p < 0.001) and LG (96.8 ± 3.2 %, p < 0.001) groups. Upsizing increased contact in the ST group by 7.0 ± 2.6 % (p < 0.001), though it did not reach levels comparable to the MD and LG groups (p > 0.05). Additionally, sagittal implant misalignment was larger in the ST group (10.1 ± 2.0°) than in the MD (7.9 ± 1.5°) and LG (3.5 ± 1.6°) groups (p < 0.001), while no difference was observed in coronal implant alignment.
Conclusion
These findings highlight the factors influencing mechanical complications of osseointegration implants and provide a basis for refined implant designs and surgical techniques for patients with short residual limbs.
{"title":"Osseointegration for transfemoral amputees: Influence of femur length and implant sizing on bone-implant contact and alignment","authors":"Matthew Cao , David B. Doherty , Hongjia He , Vinay P. Vanodia , Kristin Reeves , Sabir K. Ismaily , Jonathan J. Sauer , Shuyang Han","doi":"10.1016/j.injury.2025.112162","DOIUrl":"10.1016/j.injury.2025.112162","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical data on osseointegration (OI) for limb replacement indicates a concerning increase in mechanical complications after five years post-implantation. Since adequate bone-implant contact and proper implant alignment are critical factors for successful osseointegration, it is essential to identify the factors influencing these outcomes. This study aimed to assess the effects of residual femur length and implant sizing on bone-implant contact and implant alignment.</div></div><div><h3>Methods</h3><div>Three-dimensional models of eight cadaveric femora were reconstructed from CT scans, and transfemoral amputations were simulated for each femur at three levels: short (ST: 1/3 L), medium (MD: 1/2 L), and long (LG: 2/3 L). Virtual OI surgeries were then performed using computer-aided design (CAD) models, and implant sizes were recorded. Subsequently, the effect of implant sizing was assessed by adjusting the implant size by ±1 mm. Contact length and implant alignment were compared between the groups using repeated measures analysis of variance with Bonferroni correction.</div></div><div><h3>Results</h3><div>The contact in the ST group (65.2 ± 7.3 %) was significantly less compared to the MD (96.1 ± 4.1 %, <em>p</em> < 0.001) and LG (96.8 ± 3.2 %, <em>p</em> < 0.001) groups. Upsizing increased contact in the ST group by 7.0 ± 2.6 % (<em>p</em> < 0.001), though it did not reach levels comparable to the MD and LG groups (<em>p</em> > 0.05). Additionally, sagittal implant misalignment was larger in the ST group (10.1 ± 2.0°) than in the MD (7.9 ± 1.5°) and LG (3.5 ± 1.6°) groups (<em>p</em> < 0.001), while no difference was observed in coronal implant alignment.</div></div><div><h3>Conclusion</h3><div>These findings highlight the factors influencing mechanical complications of osseointegration implants and provide a basis for refined implant designs and surgical techniques for patients with short residual limbs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112162"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054617","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 : 2025-01-17DOI: 10.1016/j.injury.2025.112147
Garrett Gordon , Brian Johnson , Olivia Marquardt , Dylan Young , Michael J. Beltran , Sarah N. Pierrie
Objective
Metabolic bone disease (MBD, referring to osteopenia and osteoporosis) and its sequelae are associated with substantial morbidity, mortality, and healthcare costs. MBD screening and bone densitometry referral are underutilized in the general population despite published screening guidelines. Prior studies have correlated vertebral body Hounsfield unit (HU) measurements with MBD. The purpose of this study is to use this method to identify the prevalence of undiagnosed MBD in patients presenting to the hospital after high energy trauma, and to determine whether opportunistic MBD screening using this method would be valuable in this cohort.
Design
Retrospective review.
Setting
Level 1 trauma center and safety net hospital.
Patients
307 patients with a high energy femur fracture who underwent abdomen/pelvis computed tomography (CT) were identified from a trauma database.
Intervention
L1 vertebral body radio density (in Hounsfield units, HU) was measured from trauma CT scans. Risk factors for MBD were identified from the medical record.
Main outcome measurements
Prevalence of MBD and proportion of patients with MBD risk factors meriting further work-up.
Results
The prevalence of MBD among high energy trauma patients was similar to the age-matched general population. Over half (50.5 %) of all patients had at least one risk factor for MBD. Among patients 50 to 64 years of age with any given MBD risk factor, over a third of individuals had MBD. In this population, the prevalence of MBD was highest (40.0 %) among those who used tobacco products and had a concurrent alcohol use disorder.
Conclusion
Opportunistic screening for MBD using a CT measurement technique can facilitate earlier diagnosis and treatment for affected individuals presenting after high energy trauma. Opportunistic screening may be particularly impactful in pre-menopausal women and in men, who frequently have MBD risk factors but who have a low referral rate for bone density testing and treatment.
Level of evidence: Diagnostic level III.
{"title":"Opportunistic screening for metabolic bone disease in high energy fracture patients","authors":"Garrett Gordon , Brian Johnson , Olivia Marquardt , Dylan Young , Michael J. Beltran , Sarah N. Pierrie","doi":"10.1016/j.injury.2025.112147","DOIUrl":"10.1016/j.injury.2025.112147","url":null,"abstract":"<div><h3>Objective</h3><div>Metabolic bone disease (MBD, referring to osteopenia and osteoporosis) and its sequelae are associated with substantial morbidity, mortality, and healthcare costs. MBD screening and bone densitometry referral are underutilized in the general population despite published screening guidelines. Prior studies have correlated vertebral body Hounsfield unit (HU) measurements with MBD. The purpose of this study is to use this method to identify the prevalence of undiagnosed MBD in patients presenting to the hospital after high energy trauma, and to determine whether opportunistic MBD screening using this method would be valuable in this cohort.</div></div><div><h3>Design</h3><div>Retrospective review.</div></div><div><h3>Setting</h3><div>Level 1 trauma center and safety net hospital.</div></div><div><h3>Patients</h3><div>307 patients with a high energy femur fracture who underwent abdomen/pelvis computed tomography (CT) were identified from a trauma database.</div></div><div><h3>Intervention</h3><div>L1 vertebral body radio density (in Hounsfield units, HU) was measured from trauma CT scans. Risk factors for MBD were identified from the medical record.</div></div><div><h3>Main outcome measurements</h3><div>Prevalence of MBD and proportion of patients with MBD risk factors meriting further work-up.</div></div><div><h3>Results</h3><div>The prevalence of MBD among high energy trauma patients was similar to the age-matched general population. Over half (50.5 %) of all patients had at least one risk factor for MBD. Among patients 50 to 64 years of age with any given MBD risk factor, over a third of individuals had MBD. In this population, the prevalence of MBD was highest (40.0 %) among those who used tobacco products and had a concurrent alcohol use disorder.</div></div><div><h3>Conclusion</h3><div>Opportunistic screening for MBD using a CT measurement technique can facilitate earlier diagnosis and treatment for affected individuals presenting after high energy trauma. Opportunistic screening may be particularly impactful in pre-menopausal women and in men, who frequently have MBD risk factors but who have a low referral rate for bone density testing and treatment.</div><div>Level of evidence: Diagnostic level III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112147"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082456","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 : 2025-01-17DOI: 10.1016/j.injury.2025.112163
N.H.M. Ponds , J.R. Raats , D.T. Brameier , H.J. Schuijt , D. van der Velde , M.J. Weaver
Background
Older adults make up an increasing portion of orthopedic trauma care. Proxy reports are particularly valuable when patients face difficulties formulating answers due to pre-existing or temporary cognitive impairment, and provide critical insights into patient well-being.
Questions/purposes
This study examines the agreement between patient- and proxy-reported outcome measures across various health domains of older adult orthopedic trauma patients, including those with mild cognitive impairment.
Patients and methods
A prospective cohort study was conducted in the Orthopedic trauma clinic of two Level 1 trauma centers, involving 108 patients aged 70 years or older, with or without mild cognitive impairment, and a self-identified discernible proxy. Participants were evaluated using PROMIS measures for physical function, pain intensity, anxiety, depression, fatigue, and social roles and (instrumental) activities of daily living questionnaires. Agreement between patient and proxy assessments was analyzed using Intraclass Correlation Coefficient and Bland-Altman analyses. Subgroup comparison was made using confidence intervals.
Results
Most patients were married women with a mean age of 78 years (SD 6.2), 61 % had higher education, 67 % were walking independently, and 53 % had fractures of the pelvic ring or femur. Proxies were younger (mean age 64 years, SD 15), with 41 % being children and 40 % spouses. Significant correlations were found between patient and proxy assessments in physical function (ICC 0.74, 95 % CI 0.61-0.82), pain intensity (ICC 0.83, 95 % CI 0.74-0.89), (instrumental) activities of daily living (both ICC 0.86, 95 % CI 0.80-0.91). Moderate correlations were observed in anxiety, depression, fatigue, and participation in social roles (ICCs ranging from 0.56 to 0.66). Bland-Altman analyses confirmed good agreement with none to minimal systematic bias across all these domains.
Conclusion
Proxy-reported outcomes are valuable for evaluating health domains in older adult orthopedic trauma patients, including those with cognitive impairments. While proxies reliably assess physical and pain-related domains, additional strategies are needed to improve accuracy in more subjective domains. Future research should explore longitudinal agreements to better understand recovery perceptions over time and mitigate bias proxy-reporting, ultimately enhancing both patient care and outcomes research in geriatric orthopedic trauma patients.
{"title":"Proxy-reported outcomes accurately reflect objective patient-reported outcomes in older adult patients with traumatic orthopaedic injuries","authors":"N.H.M. Ponds , J.R. Raats , D.T. Brameier , H.J. Schuijt , D. van der Velde , M.J. Weaver","doi":"10.1016/j.injury.2025.112163","DOIUrl":"10.1016/j.injury.2025.112163","url":null,"abstract":"<div><h3>Background</h3><div>Older adults make up an increasing portion of orthopedic trauma care. Proxy reports are particularly valuable when patients face difficulties formulating answers due to pre-existing or temporary cognitive impairment, and provide critical insights into patient well-being.</div></div><div><h3>Questions/purposes</h3><div>This study examines the agreement between patient- and proxy-reported outcome measures across various health domains of older adult orthopedic trauma patients, including those with mild cognitive impairment.</div></div><div><h3>Patients and methods</h3><div>A prospective cohort study was conducted in the Orthopedic trauma clinic of two Level 1 trauma centers, involving 108 patients aged 70 years or older, with or without mild cognitive impairment, and a self-identified discernible proxy. Participants were evaluated using PROMIS measures for physical function, pain intensity, anxiety, depression, fatigue, and social roles and (instrumental) activities of daily living questionnaires. Agreement between patient and proxy assessments was analyzed using Intraclass Correlation Coefficient and Bland-Altman analyses. Subgroup comparison was made using confidence intervals.</div></div><div><h3>Results</h3><div>Most patients were married women with a mean age of 78 years (SD 6.2), 61 % had higher education, 67 % were walking independently, and 53 % had fractures of the pelvic ring or femur. Proxies were younger (mean age 64 years, SD 15), with 41 % being children and 40 % spouses. Significant correlations were found between patient and proxy assessments in physical function (ICC 0.74, 95 % CI 0.61-0.82), pain intensity (ICC 0.83, 95 % CI 0.74-0.89), (instrumental) activities of daily living (both ICC 0.86, 95 % CI 0.80-0.91). Moderate correlations were observed in anxiety, depression, fatigue, and participation in social roles (ICCs ranging from 0.56 to 0.66). Bland-Altman analyses confirmed good agreement with none to minimal systematic bias across all these domains.</div></div><div><h3>Conclusion</h3><div>Proxy-reported outcomes are valuable for evaluating health domains in older adult orthopedic trauma patients, including those with cognitive impairments. While proxies reliably assess physical and pain-related domains, additional strategies are needed to improve accuracy in more subjective domains. Future research should explore longitudinal agreements to better understand recovery perceptions over time and mitigate bias proxy-reporting, ultimately enhancing both patient care and outcomes research in geriatric orthopedic trauma patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112163"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049329","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 : 2025-01-16DOI: 10.1016/j.injury.2025.112170
Carol Lee , Justin Tilan , Brock D Foster , Eric White , John Garlich , Geoffrey S. Marecek
Objectives
The purpose of this study is to determine what demographic and anatomical variables affect successful placement of a superior medullary ramus screw, and how they affect the maximal diameter of that screw.
Methods
Design: Prognostic Level IV
Setting
Level I Trauma Center Patients/Participants: Two hundred consecutive patients underwent computed tomography (CT) of the pelvis. We included those patients aged 18 and older without osseous injury or abnormalities precluding measurement.
Intervention
3D reconstructions of the pelvis were created, and a virtual 3.5 mm cylindrical implant was placed from the pubic tubercle to the lateral cortex of the ilium. Success was defined as a bicortical virtual screw path from the ramus to the lateral ilium without cortical perforation. The cylinder was then expanded to model varying screw diameters. We then repeated this same process for unicortical retrograde screw insertion ending medial to the acetabular joint. Main Outcome Measures: Successful screw placement and maximum screw diameter.
Results
A 3.5 mm screw was successfully placed in 187 patients (93.5 %). One male (1/107, 0.9 %) and 12 females (12/93, 12.9 %) could not accommodate a 3.5 mm screw. All cases of perforation occurred lateral to the obturator foramen. Increasing height was associated with success, and male gender was associated with the ability to accommodate screws with a diameter 6.5 mm and larger.
Conclusions
Most patients can accommodate a 3.5 mm screw from the pubic tubercle to the ilium. Height and gender should be noted when planning medullary ramus fixation.
{"title":"Determinants for successful medullary fixation of the superior ramus","authors":"Carol Lee , Justin Tilan , Brock D Foster , Eric White , John Garlich , Geoffrey S. Marecek","doi":"10.1016/j.injury.2025.112170","DOIUrl":"10.1016/j.injury.2025.112170","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of this study is to determine what demographic and anatomical variables affect successful placement of a superior medullary ramus screw, and how they affect the maximal diameter of that screw.</div></div><div><h3>Methods</h3><div>Design: Prognostic Level IV</div></div><div><h3>Setting</h3><div>Level I Trauma Center Patients/Participants: Two hundred consecutive patients underwent computed tomography (CT) of the pelvis. We included those patients aged 18 and older without osseous injury or abnormalities precluding measurement.</div></div><div><h3>Intervention</h3><div>3D reconstructions of the pelvis were created, and a virtual 3.5 mm cylindrical implant was placed from the pubic tubercle to the lateral cortex of the ilium. Success was defined as a bicortical virtual screw path from the ramus to the lateral ilium without cortical perforation. The cylinder was then expanded to model varying screw diameters. We then repeated this same process for unicortical retrograde screw insertion ending medial to the acetabular joint. Main Outcome Measures: Successful screw placement and maximum screw diameter.</div></div><div><h3>Results</h3><div>A 3.5 mm screw was successfully placed in 187 patients (93.5 %). One male (1/107, 0.9 %) and 12 females (12/93, 12.9 %) could not accommodate a 3.5 mm screw. All cases of perforation occurred lateral to the obturator foramen. Increasing height was associated with success, and male gender was associated with the ability to accommodate screws with a diameter 6.5 mm and larger.</div></div><div><h3>Conclusions</h3><div>Most patients can accommodate a 3.5 mm screw from the pubic tubercle to the ilium. Height and gender should be noted when planning medullary ramus fixation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112170"},"PeriodicalIF":2.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043898","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 : 2025-01-16DOI: 10.1016/j.injury.2025.112172
Christian G Falgons , Connor C Park , Milton Lee (Chip) Routt Jr. , Ryan D DeAngelis , Stephen J Warner
Objectives
The primary aim of this study was to determine if an association exists between traumatic posterior hip dislocations and aortic injuries. Secondarily, this study assessed the incidence of chest imaging in patients with hip dislocations.
Methods
Design: Retrospective Review of a Consecutive Case Series. Setting: Academic level I trauma centre. Patient Selection Criteria: Fifteen-thousand-four-hundred-thirteen consecutive traumatically injured patients with at least one orthopaedic injury were initially identified. After excluding patients without a posterior hip dislocation after blunt trauma, seven-hundred-nine patients were included. Outcome Measurements and Comparisons: The primary outcome was the coincidence of blunt traumatic aortic injury with acute posterior dislocation of a native hip. The secondary outcome was the rates of chest imaging to screen for blunt aortic injuries in patients with posterior hip dislocations.
Results
The incidence of aortic injury with blunt trauma was 5.1 % in patients with a posterior hip dislocation and 1.6 % in patients without a posterior hip dislocation (OR = 3.3, CI: [2.3: 4.7], p < 0.001). Of the seven-hundred-nine patients with posterior hip dislocation, six hundred fifty-nine (93 %) received chest imaging as part of their initial workup, while thirty-four (4.8 %) never received chest imaging during hospitalization.
Conclusions
Despite improvements in automobile safety, this injury complex remains highly relevant. The findings advocate for routine chest imaging as part of the diagnostic trauma workup for patients with a native posterior hip dislocation.
{"title":"Traumatic hip dislocations associated with acute aortic injuries: A relevant injury complex","authors":"Christian G Falgons , Connor C Park , Milton Lee (Chip) Routt Jr. , Ryan D DeAngelis , Stephen J Warner","doi":"10.1016/j.injury.2025.112172","DOIUrl":"10.1016/j.injury.2025.112172","url":null,"abstract":"<div><h3>Objectives</h3><div>The primary aim of this study was to determine if an association exists between traumatic posterior hip dislocations and aortic injuries. Secondarily, this study assessed the incidence of chest imaging in patients with hip dislocations.</div></div><div><h3>Methods</h3><div><strong><em>Design:</em></strong> Retrospective Review of a Consecutive Case Series. <strong><em>Setting:</em></strong> Academic level I trauma centre. <strong><em>Patient Selection Criteria:</em></strong> Fifteen-thousand-four-hundred-thirteen consecutive traumatically injured patients with at least one orthopaedic injury were initially identified. After excluding patients without a posterior hip dislocation after blunt trauma, seven-hundred-nine patients were included. <strong><em>Outcome Measurements and Comparisons:</em></strong> The primary outcome was the coincidence of blunt traumatic aortic injury with acute posterior dislocation of a native hip. The secondary outcome was the rates of chest imaging to screen for blunt aortic injuries in patients with posterior hip dislocations.</div></div><div><h3>Results</h3><div>The incidence of aortic injury with blunt trauma was 5.1 % in patients with a posterior hip dislocation and 1.6 % in patients without a posterior hip dislocation (OR = 3.3, CI: [2.3: 4.7], <em>p</em> < 0.001). Of the seven-hundred-nine patients with posterior hip dislocation, six hundred fifty-nine (93 %) received chest imaging as part of their initial workup, while thirty-four (4.8 %) never received chest imaging during hospitalization.</div></div><div><h3>Conclusions</h3><div>Despite improvements in automobile safety, this injury complex remains highly relevant. The findings advocate for routine chest imaging as part of the diagnostic trauma workup for patients with a native posterior hip dislocation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112172"},"PeriodicalIF":2.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175577","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 : 2025-01-01DOI: 10.1016/j.injury.2024.112085
Christopher G. Hendrix , Sean Young , Stephen D. Forro , Brent L. Norris
{"title":"Navigating the intersection of AI and orthopaedic trauma research: Promise, pitfalls, and the path forward","authors":"Christopher G. Hendrix , Sean Young , Stephen D. Forro , Brent L. Norris","doi":"10.1016/j.injury.2024.112085","DOIUrl":"10.1016/j.injury.2024.112085","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 112085"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857317","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 : 2025-01-01DOI: 10.1016/j.injury.2024.111731
Jack H. Scaife , Hilary A. Hewes , Stephanie E. Iantorno , Christopher E. Clinker , Stephen J. Fenton , David E. Skarda , Zachary J. Kastenberg , Robert A. Swendiman , Katie W. Russell
Background
In 2004, our level 1 regional pediatric trauma center created a protocol to activate ECMO for children with suspected hypothermic cardiac arrest based on inclusion criteria: serum potassium ≤9, submersion <90 min, and core body temperature <30 °C. In 2017, Pasquier et al. developed a model to help predict the survival of adults after hypothermic cardiac arrest (HOPE score) that has not been validated in children. We sought to apply this score to our pediatric patient population to determine if it can optimize our patient selection.
Methods
This was a retrospective review of all patients cannulated onto VA ECMO for hypothermic cardiac arrest between 2004 and 2022. We used abstracted data points to calculate the HOPE score for our patient population, both with and without presumed asphyxia.
Results
Over 19 years, 18 patients were cannulated for suspected hypothermic arrest, with three survivors (17 %). The HOPE score survival prediction ranged from 1 to 86 % with presumed asphyxia and 6–98 % without presumed asphyxia. Survivor HOPE scores ranged from 9 to 86 % with presumed asphyxia and 42–98 % without presumed asphyxia. Non-survivors’ scores ranged 1–29 % with asphyxia and 6–57 % without asphyxia. A cutoff of >5 % predicted survival with asphyxia for ECMO could have decreased our cannulations by half without missing survivors.
Conclusion
ECMO can be a lifesaving measure for specific children after hypothermic arrest. However, identifying the patients that will benefit from this resource-intensive intervention remains difficult. HOPE score utilization may decrease the rate of futile cannulation in children, but multi-centered research is needed in the pediatric population.
{"title":"Optimizing patient selection for ECMO after pediatric hypothermic cardiac arrest","authors":"Jack H. Scaife , Hilary A. Hewes , Stephanie E. Iantorno , Christopher E. Clinker , Stephen J. Fenton , David E. Skarda , Zachary J. Kastenberg , Robert A. Swendiman , Katie W. Russell","doi":"10.1016/j.injury.2024.111731","DOIUrl":"10.1016/j.injury.2024.111731","url":null,"abstract":"<div><h3>Background</h3><div>In 2004, our level 1 regional pediatric trauma center created a protocol to activate ECMO for children with suspected hypothermic cardiac arrest based on inclusion criteria: serum potassium ≤9, submersion <90 min, and core body temperature <30 °C. In 2017, Pasquier et al. developed a model to help predict the survival of adults after hypothermic cardiac arrest (HOPE score) that has not been validated in children. We sought to apply this score to our pediatric patient population to determine if it can optimize our patient selection.</div></div><div><h3>Methods</h3><div>This was a retrospective review of all patients cannulated onto VA ECMO for hypothermic cardiac arrest between 2004 and 2022. We used abstracted data points to calculate the HOPE score for our patient population, both with and without presumed asphyxia.</div></div><div><h3>Results</h3><div>Over 19 years, 18 patients were cannulated for suspected hypothermic arrest, with three survivors (17 %). The HOPE score survival prediction ranged from 1 to 86 % with presumed asphyxia and 6–98 % without presumed asphyxia. Survivor HOPE scores ranged from 9 to 86 % with presumed asphyxia and 42–98 % without presumed asphyxia. Non-survivors’ scores ranged 1–29 % with asphyxia and 6–57 % without asphyxia. A cutoff of >5 % predicted survival with asphyxia for ECMO could have decreased our cannulations by half without missing survivors.</div></div><div><h3>Conclusion</h3><div>ECMO can be a lifesaving measure for specific children after hypothermic arrest. However, identifying the patients that will benefit from this resource-intensive intervention remains difficult. HOPE score utilization may decrease the rate of futile cannulation in children, but multi-centered research is needed in the pediatric population.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111731"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763523","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 : 2025-01-01DOI: 10.1016/j.injury.2024.111938
Anne Neubert , Sebastian Hempe , Carina Jaekel , Catharina Gaeth , Christopher Spering , Katharina Fetz , Joachim Windolf , Erwin Kollig , Dan Bieler , LeAf-Trauma-Group
Background
Survivors of a major trauma experience a range of difficulties in relation to the reduction in physical, psychosocial, and cognitive functions, which can result in a reduced health-related quality of life. This study aims to explore lived experiences of major trauma survivors in the German healthcare system.
Methods
Semi-structured exploratory interviews were performed with nine major trauma survivors (18–55 years; Injury Severity Score ≥16). For exploratory analyses, an artificial intelligence-based coding software was used. Further, results were clustered by using the International Classification of Functioning, Disability and Health framework (ICF).
Results
Communication was one of the major topics concerning amongst others diverting opinions between different healthcare disciplines and a general lack of information. The participants showed a high demand for a contact person. Furthermore, social support was essential during recovery for those interviewed. Social network was not only important as emotional and physical support but also for overcoming of gaps in the healthcare system. The support by employers and colleagues seemed to be beneficial for our participants in relation to returning to work. Further, psychological consequences of trauma, and that mobility is a key factor for quality of life, self-efficacy and return to work were discussed.
Discussion
The qualitative analyses highlight several topics such as communication, burden of sickness, support systems that the participants mentioned as important along their journey through the German healthcare system during recovery. Through the ICF model the interplay of certain components that influenced the outcome of the major trauma survivors was visualized.
Implications
These results might offer a deepened understanding of modifiable components of a patient pathway in recovery process such as improvements of patient communication, provision of a contact person and others.
{"title":"Lived experiences of working-age polytrauma patients in Germany - A qualitative Analysis","authors":"Anne Neubert , Sebastian Hempe , Carina Jaekel , Catharina Gaeth , Christopher Spering , Katharina Fetz , Joachim Windolf , Erwin Kollig , Dan Bieler , LeAf-Trauma-Group","doi":"10.1016/j.injury.2024.111938","DOIUrl":"10.1016/j.injury.2024.111938","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of a major trauma experience a range of difficulties in relation to the reduction in physical, psychosocial, and cognitive functions, which can result in a reduced health-related quality of life. This study aims to explore lived experiences of major trauma survivors in the German healthcare system.</div></div><div><h3>Methods</h3><div>Semi-structured exploratory interviews were performed with nine major trauma survivors (18–55 years; Injury Severity Score ≥16). For exploratory analyses, an artificial intelligence-based coding software was used. Further, results were clustered by using the International Classification of Functioning, Disability and Health framework (ICF).</div></div><div><h3>Results</h3><div>Communication was one of the major topics concerning amongst others diverting opinions between different healthcare disciplines and a general lack of information. The participants showed a high demand for a contact person. Furthermore, social support was essential during recovery for those interviewed. Social network was not only important as emotional and physical support but also for overcoming of gaps in the healthcare system. The support by employers and colleagues seemed to be beneficial for our participants in relation to returning to work. Further, psychological consequences of trauma, and that mobility is a key factor for quality of life, self-efficacy and return to work were discussed.</div></div><div><h3>Discussion</h3><div>The qualitative analyses highlight several topics such as communication, burden of sickness, support systems that the participants mentioned as important along their journey through the German healthcare system during recovery. Through the ICF model the interplay of certain components that influenced the outcome of the major trauma survivors was visualized.</div></div><div><h3>Implications</h3><div>These results might offer a deepened understanding of modifiable components of a patient pathway in recovery process such as improvements of patient communication, provision of a contact person and others.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111938"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549794","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 : 2025-01-01DOI: 10.1016/j.injury.2024.112063
Guro Bjørke , Ingvild Dalen , Kenneth Thorsen
Background
The Norwegian trauma plan was established in 2007 and renewed in 2017 defining national trauma team activation (TTA) criteria. Norwegian studies validating the performance of previous TTA protocols have found overtriage and undertriage to be out of line with the quality indicators set in the national trauma plan, but studies have not yet been published validating the new TTA protocol.
Material and method
This was a registry study of a prospectively maintained database in the period from 01/01/2018 to 12/31/2020. Data were collected from the Trauma Registry including prehospital documents. A total of 1519 patients were eligible, of which 95 were excluded, yielding a study population of 1424 patients. All patients were evaluated for a total of 29 criteria in four criteria groups: 1 Physiology, 2 Anatomical injury, 3 Mechanism of injury, and 4 Special considerations. Overtriage, undertriage, sensitivity and positive predictive value (PPV) were estimated for the current and alternative TTA protocols, criteria groups, and single criteria.
Results
The current Norwegian TTA protocol involving criteria groups 1–3 had a total sensitivity of 84.8 %, hence an undertriage of 15.2 % (95 % confidence interval, 11.1–20.3 %), and PPV of 19.2 % hence an overtriage of 80.8 % (78.3–83.1 %). Patients 60 years and older had an undertriage of 21.6 %, whilst patients under 60 years of age had an undertriage of 11.2 %. A TTA protocol including criteria group 4 as well yielded a lower undertriage (5.6 %) without significantly increasing overtriage (81.7 %), and a TTA protocol with criteria group 4 replacing group 3 yielded an undertriage of 7.4 % and an overtriage of 81.0 %. Criteria group 3 Mechanism of injury was the criteria group with the most overtriage, at 95 %. Patients that did not meet any criteria had a similar overtriage of 94 %.
Conclusion
Both overtriage and undertriage are out of line with the goals set in the Norwegian trauma plan. Undertriage is often caused by older patients that do not fulfill the trauma criteria in the current TTA protocol. Mechanism of injury increases overtriage but does not reduce undertriage. The TTA protocol could be improved by changing the composition of criteria groups, removal of single criteria with low PPV, and by better compliance to the existing criteria.
{"title":"Accuracy of the Norwegian trauma protocol. An observational population study from South-Western Norway","authors":"Guro Bjørke , Ingvild Dalen , Kenneth Thorsen","doi":"10.1016/j.injury.2024.112063","DOIUrl":"10.1016/j.injury.2024.112063","url":null,"abstract":"<div><h3>Background</h3><div>The Norwegian trauma plan was established in 2007 and renewed in 2017 defining national trauma team activation (TTA) criteria. Norwegian studies validating the performance of previous TTA protocols have found overtriage and undertriage to be out of line with the quality indicators set in the national trauma plan, but studies have not yet been published validating the new TTA protocol.</div></div><div><h3>Material and method</h3><div>This was a registry study of a prospectively maintained database in the period from 01/01/2018 to 12/31/2020. Data were collected from the Trauma Registry including prehospital documents. A total of 1519 patients were eligible, of which 95 were excluded, yielding a study population of 1424 patients. All patients were evaluated for a total of 29 criteria in four criteria groups: <em>1 Physiology, 2 Anatomical injury, 3 Mechanism of injury</em>, and <em>4 Special considerations</em>. Overtriage, undertriage, sensitivity and positive predictive value (PPV) were estimated for the current and alternative TTA protocols, criteria groups, and single criteria.</div></div><div><h3>Results</h3><div>The current Norwegian TTA protocol involving criteria groups 1–3 had a total sensitivity of 84.8 %, hence an undertriage of 15.2 % (95 % confidence interval, 11.1–20.3 %), and PPV of 19.2 % hence an overtriage of 80.8 % (78.3–83.1 %). Patients 60 years and older had an undertriage of 21.6 %, whilst patients under 60 years of age had an undertriage of 11.2 %. A TTA protocol including criteria group 4 as well yielded a lower undertriage (5.6 %) without significantly increasing overtriage (81.7 %), and a TTA protocol with criteria group 4 replacing group 3 yielded an undertriage of 7.4 % and an overtriage of 81.0 %. Criteria group <em>3 Mechanism of injury</em> was the criteria group with the most overtriage, at 95 %. Patients that did not meet any criteria had a similar overtriage of 94 %.</div></div><div><h3>Conclusion</h3><div>Both overtriage and undertriage are out of line with the goals set in the Norwegian trauma plan. Undertriage is often caused by older patients that do not fulfill the trauma criteria in the current TTA protocol. Mechanism of injury increases overtriage but does not reduce undertriage. The TTA protocol could be improved by changing the composition of criteria groups, removal of single criteria with low PPV, and by better compliance to the existing criteria.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 112063"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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