Injury最新文献

Introduction: Preliminary results suggest that placement of stent grafts is a safe method of treating carotid traumatic injuries, but data on late follow-up are limited, therefore this study evaluated in hospital and long-term outcomes of endovascular treatment of carotid artery injuries DESIGN: single centred, retrospective METHODS: This study evaluated patients admitted at University of São Paulo School of Medicine from 2011 to 2024. Complications, mortality, stroke rates and carotid patency were assessed.

Results: Sixteen patients underwent endovascular treatment of their carotid artery injuries during the study period. They were male; with a mean age of 34 ± 11 years. Most injuries resulted from penetrating trauma (12 out of 16). At hospital admission, the median Injury Severity Score (ISS) was 13 (IQR 9-18.5), Revised Trauma Score (RTS) was 8 (IQR 6.75-8) and Glasgow Coma Score (GCS) was 15 (IQR 4.25-15) and five patients had neurological deficits. The common carotid artery was the most frequently injured artery (9/16), while pseudoaneurysms constituted the most common type of arterial injury (13/16). Patients underwent endovascular repair of their vascular injuries via stent graft implantation (nine stent grafts were placed in the common carotid artery, three in the carotid bulb and four in the internal carotid artery). There was no intervention related stroke. Eleven patients were discharged in good condition, four patients had neurological impairment (stable comparing to their deficit at hospital admission) and one patient died due to a contralateral haemorrhagic stroke. Ipsilateral stroke-free survival rate was 62 % at hospital discharge. The mean follow-up time was 43.5 months (IQR 16-61.75). The primary patency of the stent grafts was 100 % at 12 months, 83 % at 24 months, and 73 % at 24 months. Three occlusions were reported, all occurring in stent grafts located within the internal carotid artery. these occlusions were asymptomatic.

Conclusion: This study highlights the safety of stent graft repair in a selected cohort of patients with carotid injury. It was observed that stent grafts implanted in the internal carotid artery are prone to late, often asymptomatic occlusion, underscoring the importance of surveillance. However, multicentre prospective studies are still needed to establish best practice.

Introduction: Fractures and soft tissue damage are the main causes for traumatic peripheral nerve injuries. Discontinuity of peripheral nerve after injury results in loss of motor function or sensation or both combined. This is often associated with debilitating consequences for the affected person. Current data on the epidemiology of peripheral nerve injuries in Germany are scarce.

Material and methods: In a non-interventional retrospective population-based cohort study (registry-based), publicly available, anonymized patient data (2019-2023) were analyzed with respect to traumatic peripheral nerve injuries (PNI). Incidences regarding PNI in total and stratified to gender, age and anatomic regions were calculated and stratified to the official German reference population/100,000.

Results: The incidence for a peripheral nerve injury in Germany as a concomitant trauma diagnosis is 11.27 (95CI 10.39; 12.2)/100,000. Males are more than twice as likely as females to have a PNI, with a ratio of 2.17:1. The most common site for PNI is the forearm, wrist, and hand. 55.83% (95CI 55.01; 56.65) are between the ages of 18-49. 22.88% of all registered peripheral nerve injuries are caused by a bone fracture.

Conclusion: In conclusion, a national mean incidence for traumatic peripheral nerve injuries was evaluated with 11.27 (95CI 10.39; 12.2) /100,000 stratified to the German standard population.

Introduction: As screening protocols for blunt cerebrovascular injuries (BCVI) have improved, the incidence of these injuries has increased among trauma patients. Grade 2 BCVIs represent a heterogeneous group of vascular injuries and include injuries with thrombus. We hypothesize that the presence of intraluminal thrombus in patients with grade 2 BCVI is associated with a higher incidence of stroke compared to those without thrombus.

Methods: We conducted a single-center retrospective review of trauma patients diagnosed with BCVI at a Level I Trauma Center from November 2015 to October 2023. Demographic and injury characteristics were obtained from the institutional trauma registry. Detailed chart reviews were performed to assess imaging findings, stroke incidence, interventions, and follow-up outcomes. Additionally, all grade 2 BCVIs underwent secondary review by neuroradiologists to confirm grade and to identify whether thrombus was present.

Results: We identified a total of 39 patients with at least one grade 2 BCVI. The overall stroke rate among those with grade 2 BCVI was 23% (n = 9). Intraluminal thrombus was present in 31% of patients (n = 12); however, the stroke rate among these patients was similar (25%, n = 3). Incidence of stroke did not significantly differ based on whether patients received an intervention, anti-platelet therapy, or no therapy. Follow-up imaging was performed in 64% of patients (n = 25), demonstrating that 24% of injuries resolved, 24% improved, 40% remained stable, and 16% progressed. Nearly two-thirds of patients (n = 25) underwent at least one repeat CTA during their hospitalization or outpatient follow-up with a median number of 38 days to repeat imaging when performed.

Conclusion: Although grade 2 BCVIs are often considered lower risk injuries, our findings indicate that over 20% of affected patients experience a stroke. The presence of intraluminal thrombus was not associated with an increased risk of stroke. These findings support the early initiation of antithrombotic therapy in patients with grade 2 BCVI to mitigate stroke risk.

Background: Vascular compromise is a serious complication in free-flap surgery for traumatic reconstruction or fracture-related infections, often leading to partial or total flap loss if not detected promptly. We evaluated transcutaneous partial pressure of carbon dioxide (TcPCO₂) real-time monitoring as an objective, non-invasive method for ultra-early detection of vascular compromise in free flap reconstruction.

Methods: This sequential cohort study consisted of a retrospective development phase and a prospective validation phase. An abnormality was defined as a rise of >10 mmHg from the baseline TcPCO₂ value, with re-exploration performed if the elevation persisted after recalibration. High-resolution (1-s interval) TcPCO₂ data were analyzed to assess diagnostic accuracy and concordance with arterial partial pressure of carbon dioxide (PaCO₂).

Results: In pilot studies, TcPCO₂ increased within 20-100 s of induced ischemia and correlated strongly with PaCO₂ (r = 0.708, p < 0.001). Among 81 clinical free flap cases (50 retrospective, 31 prospective), TcPCO₂ monitoring detected all seven episodes of vascular compromise with 100% sensitivity and specificity, and no false positives. All the compromised flaps were successfully salvaged. Compared with conventional clinical assessment, TcPCO₂ monitoring provided earlier recognition of perfusion disturbances.

Conclusion: TcPCO₂ monitoring is a non-invasive, objective, and reproducible tool for ultra-early detection of vascular compromise in free flap surgery. Its implementation enables timely re-exploration, reduces reliance on subjective bedside assessments, and may significantly improve flap salvage outcomes.

Background: Trauma is a major global health burden leading to significant morbidity, disability, and mortality. Predictive models in trauma care traditionally focus on mortality, but early predictions of hospital length of stay (LOS) and intensive care unit (ICU) needs could greatly enhance hospital planning and resource allocation. Machine learning (ML) offers new possibilities for developing prediction tools for these outcomes but remain underexplored in large, unselected trauma populations.

Aim: To develop and validate machine learning-based models for early prediction of hospital length of stay and ICU admission among severely injured trauma patients using a large patient cohort from a national trauma registry.

Methods: Patient data from 9056 adult severely injured trauma patients (NISS >15) registered in the Swedish trauma registry SweTrau between 2015 and 2019 were analyzed. Only variables available at hospital arrival were used as predictors. Outcomes were LOS (1-2, 3-9, or ≥10 days) and ICU admission (yes/no). Patients from 2015 to 2018 (n = 6706) were used for training Generalized Linear Model (GLM), Random Forest (RF), and Extreme Gradient Boosting (XGB) models, and patients from 2019 (n = 2350) were used for temporal internal-external validation. Model performance was assessed with ROC curves, calibration curves and DCA.

Results: The XGB models consistently outperformed GLM and RF models for all outcomes. For estimation of ICU admission, the XGB model achieved an AUC of 0.85 (95% CI: 0.84-0.87). For estimations of LOS, the XGB model achieved "one-vs- all" AUCs of 0.69, 0.64, and 0.71 for the three LOS categories, respectively. A clinical prediction tool based on the best-performing models was created and is available online (https://hipfx.shinyapps.io/traumaadvisorapp/).

Conclusion: Machine learning models trained on national trauma registry data demonstrated strong performance in predicting ICU admission and moderate accuracy in categorizing hospital length of stay. The XGB model showed the highest overall predictive power and may serve as a useful tool to support early triage, guide clinical decision-making, and optimize resource allocation in trauma care settings.

Background: Thoracic epidural anesthesia and paravertebral blocks (PVBs) are the gold standard techniques for pain relief of chest trauma, but they are technically challenging and have failure rates. The Erector Spinae Plane block (ESPB) is a PVB surrogate that provides effective hemi-thoracic analgesia. The costotransverse foramen block (CTFB) is a novel block that deposits local anaesthetic adjacent to the costotransverse foramen. We hypothesized that CFTB might offer superior analgesia compared to ESPB.

Methods: This double-blinded, prospective, randomized controlled trial was conducted in the emergency department (ED) of a tertiary care institution. Fifty-eight patients with chest trauma were randomized into two groups, Group-1 (USG-ESPB; n = 29) or Group-2 (USG-CTFB; n = 29). The primary outcome was to compare pain scores in the Numeric Rating Scale (NRS) at 20 min. The secondary outcomes were onset and duration of analgesia, pain score at fixed time intervals, block failure rates, need for rescue analgesia, assessment of pain score at one and three months, and adverse events.

Results: Demographic and vital parameters were similar between the two groups. Baseline pain scores recorded at rest [9.6(0.8) vs 9.5(0.9)] and on movement [9.8(0.6) vs 9.8(0.6)] did not differ. At 20 min following intervention, mean pain scores at rest were very similar in both groups [5.2 (1.7) vs. 5.3 (1.5)] (mean difference: 0.1; 95% CI: -0.55 to 0.50; P = 0.94). Pain scores during movement were also very similar in both groups [6.4 (1.7) vs. 6.3 (1.4)] (mean difference: 0.1; 95% CI: -0.43 to 0.62; P = 0.76). The NRS score was persistently lower in the CTFB group at all other designated time points, though the difference was not statistically significant. The onset, duration, requirement of rescue analgesia, and block failure were similar. There were no complications in any group. During assessments at one and three months, both techniques yielded equivalent pain control.

Conclusion: CTFB provides analgesia equivalent to ESPB in terms of acute and long-term pain relief, onset, duration, and opioid consumption for chest trauma patients. CTFB, however, is technically more challenging, and ESPB is a safer and more user-friendly option.

Background: Gamified virtual patients (VPs) can enhance motivation and learning in military trauma management. However, there is a need to better understand design preferences and expectations regarding VP features and game elements. This study explores how such elements are experienced and interpreted by military trauma care professionals.

Methods: This qualitative study applied systematic text condensation to analyze the shared experiences of 17 participants, consisting of military medics and instructors, who interacted with a gamified VP system.

Results: Five main themes were identified: Feeling Challenged; Supporting Reflection and Learning; Realism Matters; Developing Confidence; and Balancing Learning and Playing. Participants expressed mixed views on game rewards, competition, and time-pressure, with instructors warning that such features could detract from learning objectives. Instructors emphasized the value of feedback that explains consequences, while both instructors and medics highlighted the importance of immediate corrective feedback.

Discussion: Gamified VPs can support military trauma training by enhancing engagement, building confidence, and supporting reflection and learning. However, the inclusion of game elements requires careful consideration. Elements that contribute to realism and immersion, such as narrative, multimedia, and tactical challenges, were viewed as valuable for maintaining authenticity and contextual relevance. Hints and progressive difficulty levels were also perceived as beneficial for supporting gradual skill development. Features such as scoring, competition, rewards and time-pressure elicited mixed responses. While some participants found these elements engaging, others perceived them as distracting or misaligned with the goal of acquiring life-saving skills. Instructors were critical of mechanisms that induced artificial stress or rewarded speed over reasoning, warning that such features could shift focus from learning to performance. Therefore, rather than adopting gamification features uncritically, designers and educators should carefully evaluate which elements enhance learning in high-stakes environments and which risk undermining it.

Background: Post-burn elbow flexion contractures significantly impair upper-limb function by restricting the essential functional arc of motion required for activities such as self-care, feeding, hygiene, and vocational tasks. Standard management using contracture release and skin grafting is limited by high rates of recontracture due to secondary graft contraction. Locoregional perforator flaps based on the radial recurrent or ulnar recurrent vessels are often missed, even though they offer thin, pliable, and durable tissue. This study evaluates the flap surface area required to resurface the elbow flexure crease and analyzes postoperative functional outcomes using the Mayo Elbow Performance Score (MEPS).

Methods: A prospective observational study was conducted over a three-year period in a tertiary care plastic surgery department. Patients aged 12 years and older presenting with post-burn elbow flexion contractures and with either the radial or ulnar border of the arm unaffected were included. Flap area was estimated from the contralateral limb or an age- and sex-matched individual in bilateral cases. Radial recurrent artery perforator (RRAP) or ulnar recurrent artery perforator (URAP) flaps were harvested based on perforator availability. MEPS was recorded preoperatively and at 6 weeks postoperatively. Early mobilization was initiated within 48 h, and donor sites were grafted as needed.

Results: Twelve patients out of 38 (31%) (eight males, four females; mean age, 34 years) met the inclusion criteria. Flame burns accounted for 9 cases, and scald injuries for 3. The mean flap area required to reconstruct the flexure crease was 39 cm². Preoperatively, elbow function was markedly limited, with a mean MEPS of 60 (range 45-70). Following contracture release and flap resurfacing, early mobilization was achieved in all patients without the need for postoperative splinting. At 6 weeks, the mean MEPS improved significantly to 98 (range 95-100), confirmed by Wilcoxon rank-sum testing (p< 0.05). No flap failures, wound complications, or early recontractures were noted.

Conclusion: Radial and ulnar recurrent artery perforator flaps provide reliable, thin, and contour-appropriate tissue for resurfacing the elbow flexure crease after burn contracture release. Their ability to permit early mobilization and prevent recontractures makes them an effective primary reconstructive option in about 31% of cases.

Background: The 2023-2025 war on Gaza has severely impacted healthcare infrastructure, necessitating the establishment of makeshift facilities to manage war-related injuries. This study evaluates the outcomes and resource accessibility for emergency laparotomy or thoracotomy injuries in a makeshift trauma surgery unit in Gaza during the war.

Methods: A prospective cohort study was conducted from July 16 to August 31, 2024, including consecutive patients with war-related injuries who underwent emergency laparotomy or thoracotomy, with 30-day follow-up. Obstetrics and gynecology facilities were repurposed as a trauma surgery unit. Outcomes included mortality, complications, unplanned reoperations, and resource accessibility.

Findings: Among 79 patients, 84% (66/79) sustained injuries due to blast mechanism, of which 53% (35/66) were prehospital reported as caused by airstrikes. 94% (74/79) underwent emergency laparotomy, 9% (7/79) underwent emergency thoracotomy, and 3% (2/79) underwent both surgeries. In-hospital mortality was 32% (25/79). Postoperative complications occurred in 69% (51/74), with surgical site infections being the most common (58%, 43/79). Additionally, 15% (11/74) required an unplanned return to the operating theater. Only 5% (4/79) had access to preoperative CT imaging. 62% (49/74) of patients were treated postoperatively in corridors or outdoors. 56% (24/43) of patients were lost to follow-up by day 30.

Conclusion: This study describes severe truncal trauma managed in a makeshift civilian facility with limited medical resources, where non-surgical hospital spaces were repurposed for trauma care. High rates of mortality and postoperative complications were observed, and basic surgical resources were unavailable for the majority of patients. A trauma database was able to be maintained despite the constraints of a humanitarian crisis.