Injury最新文献

Introduction: To help address the continuing epidemic of firearm-related trauma in the United States (US), we conducted a detailed analysis of recent trauma center discharge data and compared firearm-related injuries to mechanisms such as falls, pedestrian injuries, and motor vehicle crashes.

Methods: We combined Trauma Quality Improvement Program (TQIP) data for 2011 to 2022 and analyzed variables for patient demographics, injury mechanisms, disposition, and hospital characteristics over time. Analyses consisted of descriptive statistics, bar plots, time series plots, and comparative tables.

Results: There were 3,597,688 US trauma hospital discharges in the TQIP data set for 2011 to 2022 of which 307,062 (8.4%) involved firearms-a higher proportion than those involving pedestrian injuries (3.8%), pedal cycles (2.0%), or motorcycles (6.2%). The case-fatality rate of inpatient hospital deaths for firearm injuries was 8.8%, surpassed only by that of pedestrian injuries (9.9%). Firearms accounted for the youngest patient population over the 12-year study period for the six injury mechanisms analyzed. Over time, firearm-related assaults increased from 75.7% of all firearm injuries in 2011 to 88.6% in 2020. Most, if not all, of this increase appeared to occur in the post-2014 time period.

Conclusions: Better defining national injury trends allows for targeted injury prevention efforts, prioritized research endeavors, and optimized resource allocation.

Background: The Noto Peninsula earthquake of January 1, 2024, was the most destructive seismic event in Japan since 2011, affecting a region characterized by its super-aging population, geographical isolation, and status as a medically underserved area. These vulnerabilities require a detailed analysis of the acute-phase medical response to improve disaster preparedness in similar environments. This study aims to characterize the morbidity and features of earthquake-affected patients admitted to a regional tertiary university hospital.

Methods: We conducted a retrospective observational study of patients presenting to the emergency department of Kanazawa University Hospital between January 1, 2024, and January 31, 2024, with earthquake-related conditions. Patients with direct trauma or secondary health issues (e.g., exacerbation of chronic illness) were identified by a multidisciplinary Disaster Response Committee. All patients were triaged using the Japan Triage and Acuity Scale (JTAS). Descriptive statistics were used to summarize demographics, clinical characteristics, and transport modalities.

Results: A total of 144 earthquake-related patients were managed. The cohort was characterized by a high mean age (79.7 years) and a female predominance (61.1%). The primary medical burden was the exacerbation of intrinsic diseases (74.3%), while trauma cases were less frequent (23.6%). The majority of patients presented with low to moderate acuity; severe cases (JTAS Levels 1-2) constituted 7.0% of the cohort, whereas low-acuity Level 4 was the largest (63.2%). Patient transport peaked on day five, almost exclusively by air evacuation (97.7% of arrivals that day), which was essential to overcome extensive road damage. The base-isolated hospital sustained no major damage and remained fully operational, serving as a regional DMAT command post.

Conclusions: The medical response to the Noto earthquake highlights a paradigm shift in disaster care for aging societies, where management of geriatric and chronic diseases takes precedence over mass-casualty trauma care. In isolated regions, air evacuation is a critical yet weather-vulnerable modality for effective patient transport. Future disaster preparedness requires a dual focus: medical response plans must prioritize systems for chronic and geriatric care, and strategic investment in seismically resilient tertiary hospitals is essential for them to function as stable operational hubs, ensuring regional continuity of care.

Introduction: Rapid economic growth may impact trauma mortality. We investigated the epidemiology, risk factors and trends in hospital mortality of admitted trauma patients in Guyana during a 5-year period of rapid economic growth in this country.

Patients and methods: The study was conducted at the Georgetown Public Hospital Corporation, Guyana's largest tertiary healthcare facility. The medical records of all patients admitted following trauma between 2018 and 2022 were reviewed. Patient demographics, injury characteristics, and clinical outcomes (mortality and length of stay) were obtained for each study year. Univariate analyses assessed the distributions of all variables while adjusted regression analyses were used to identify potential risk factors for in-hospital mortality. P-values ≤ 0.05 were considered statistically significant.

Results: The in-hospital mortality rate was 3.5% (n=190). The highest in-hospital mortality rate occurred among burns patients (11.2%), and the lowest from assaults (1.9%). Risk factors for death were mechanism of injury, ethnicity, injury severity at presentation, and age. The leading mechanisms of injury for trauma-related deaths were motor vehicle crashes (39.5%) and falls (24.7%). Females had over twice the rate of death from falls compared to males (6.3% vs. 3.1%). Among ethnicities, Indo-Guyanese patients had the highest odds of dying from trauma compared to Afro-Guyanese (OR 2.37 CI 1.57-3.56, p<0.01) primarily driven by motor vehicle crashes (OR 3.29, CI 1.65, 6.55 p<0.01). The median (Q1, Q3) length of stay was 3 (1, 6) days. Most patients (73.5%) died within 7 days of admission. Late deaths (≥24h of admission) occurred in 53.6% of patients. Annual mortality rates fluctuated during the study period coinciding with Covid -19 restrictions but rose overall by 86.5% from 3.7% in 2018 to 6.9% in 2022. Annual comparisons of mortality rate with GDP growth rate showed parallel increases over most of the study period.

Conclusion: This study provides evidence to support targeted clinical practice and public health initiatives to prevent increases in trauma mortality in Guyana and other rapidly developing countries facing rising injury risks.

Introduction: Post Traumatic Stress Disorder (PTSD) is not uncommon following major trauma. Despite increasing awareness of the psychological sequelae of trauma, there is often inadequate mental health follow-up for trauma patients. This can lead to significant rates of under-diagnosis and under-treatment.

Aims: To examine rates of under-diagnosis and under-treatment of probable PTSD amongst major trauma patients admitted to Christchurch Hospital, New Zealand.

Methods: A prospective questionnaire-based cohort study including patients 16 years and older who presented to Christchurch Hospital with major trauma (Injury Severity Score >/=12) between May 2016 and September 2018. Patients with severe brain injury were excluded. Patients who consented completed the Posttraumatic Stress Disorder Checklist for DSM-V (PCL-5), plus answered questions on any assessment, treatment or diagnosis of PTSD, depression or anxiety before and/or after injury. Demographic, injury-specific and hospital care data were collated from the New Zealand Major Trauma Registry.

Results: There were 836 patients who met the eligibility criteria and were invited to participate in the study, with a 24% response rate (203 patients). Thirty-seven (18%) scored at or above the PTSD threshold, however only 8 (22%) reported having received a formal diagnosis of PTSD. All 8 patients who had received a formal diagnosis of PTSD were receiving some form of mental health treatment (either medication, 'talk therapy' or both). By comparison, within the group of 29 patients who had not received a diagnosis of PTSD but met criteria, only 11 (38%) were receiving any form of mental health treatment.

Conclusion: Many people who develop PTSD following trauma fail to receive appropriate assessment, diagnosis or treatment. Further work is needed to ensure adequate systems are in place to allow identification and treatment of patients who develop PTSD following a major trauma.

Background: Early and adequate analgesia is a critical component of injury care. While sociodemographic factors have been shown to impact the adequacy of analgesia in a variety of clinical settings, these relationships are poorly understood in trauma care. Our objective was to evaluate the association between patient and provider characteristics and time to analgesia during trauma resuscitation.

Methods: We performed a retrospective cohort study of adult (age ≥ 16) patients presenting as trauma activations at a level I trauma center over 2 years (2019-2020). Data were derived from the institutional trauma registry and chart review. Time from presentation to first administration of analgesia was recorded. The primary outcome was delayed analgesia, defined as analgesia administered later than the 75th percentile of time to analgesia for all patients. Multivariable logistic regression was used to evaluate the effect of age, sex, and socioeconomic status on analgesia timing.

Results: Among 2497 patients meeting inclusion criteria (mean age 44.8 years [SD 21.6], 25.7% female), 1957 (77.5%) received analgesia in the trauma bay. Among patients who received analgesia in the trauma bay, median time to analgesia was 9 min (IQR 7-14). The only sociodemographic characteristic independently associated with delayed analgesia was age. Relative to patients aged 16-54, those aged 55-64 were 1.5-fold more likely to receive delayed analgesia (OR 1.46; 95% CI 1.05-2.03), while those aged ≥ 65 were twice as likely to have delayed analgesia (OR 2.16; 95% CI 1.58-2.95). Irrespective of age or injury severity, patients injured in falls were more likely to experience delayed analgesia (OR 1.64; 95% CI 1.20-2.23).

Conclusion: Older adults and patients injured in a fall are more likely to experience delays in receiving analgesia. Strategies that ensure equity in pain management are needed such that all patients have equitable access to early and adequate pain control after injury.

Introduction: Prehospital erythrocyte transfusion, well-established in the management of hemorrhagic shock in developed countries, was incorporated into trauma care in Brazil in 2022, representing a significant advance in the treatment of severe trauma. This study aimed to describe the clinical profile of patients with severe trauma who received prehospital erythrocyte transfusion by the SAMU aeromedical team in a health macro-region in Southern Brazil.

Methods: This retrospective cross-sectional study (2022-2024) included patients with severe trauma treated by a regional SAMU aeromedical team who received prehospital erythrocyte transfusion at the trauma scene. Clinical, laboratory, and hemodynamic variables were collected, including prehospital and hospital shock index values. The primary outcome was 24-hour mortality. Associations with early mortality were explored using Fisher's exact test with exact odds ratios. Changes in shock index between prehospital and hospital moments were evaluated with the Wilcoxon signed-rank test, while differences between survivors and non-survivors were assessed with the Mann-Whitney test.

Results: Results: Thirty-eight patients were included, and 10 (26%) died within 24 hours. Prehospital erythrocyte transfusion was associated with a significant reduction in shock index, decreasing from a median of 1.85 (IQR 1.53-2.40) at the scene to 1.15 (IQR 0.90-1.68) on hospital arrival (p < 0.001), with no difference in the magnitude of reduction between survivors and non-survivors (p = 0.38). Non-survivors presented a more unfavorable metabolic profile on admission, with lower base excess and hematocrit and higher lactate levels. Older age (≥60 years) and a positive FAST showed higher odds of early mortality (OR 5.2 and 5.8, respectively), although both associations had wide confidence intervals and two-sided Fisher p-values of 0.06. All seven patients who experienced cardiac arrest at the scene died within 24 hours. No transfusion-related adverse events were recorded; however, key physiological parameters such as ionized calcium and core temperature were not systematically monitored.

Conclusion: Prehospital erythrocyte transfusion was feasible within this aeromedical service and was associated with early improvement in shock index. Although no transfusion-related adverse events were recorded, incomplete physiological monitoring limits definitive conclusions regarding safety. These findings support the potential role of prehospital transfusion as a supportive measure in severe trauma, particularly in aeromedical settings.

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.