Injury最新文献

Purpose: Tibial plateau fractures are often surgically treated to restore native joint congruity and articular alignment. While these injuries portend an increased risk for end stage knee osteoarthritis, it is unknown whether the fixation constructs contribute to the development of osteoarthritis by influencing articular stress distribution following instrumentation.

Methods: We conducted a cadaver study measuring resultant intra-articular stresses of the native knee due to physiological levels of ex-vivo loading, after instrumentation with plate and screw fixation, and after implant removal. To account for variable subchondral bone density, we used 3D printed bone with osteoporotic and normal cancellous bone volume fraction, and SawBones where there is no appreciable cancellous bone.

Results: There was no statistical difference in peak, average, or total contact pressures following implant fixation and removal from the preimplantation articular pressure states in all loads and all models (p > 0.05). There was also no difference between the pressure changes of the cadaveric and Sawbones models. There were statistically significant pressure changes between cadaveric and 3D printed models following fixation, however these changes were within previously described physiologic loads (<10 MPa).

Conclusions: Subchondral instrumentation of tibial plateau fractures did not materially alter articular pressures. These findings suggest that the development of end-stage knee osteoarthritis may not be a result of altered biomechancial stresses from the instrumentation. Further, elective removal of implants is not supported by biomechanical reasons alone to reduce future risk. Supplementing cadaveric studies with patient-specific models while tuning variables can enhance the fidelity of these investigations.

Statement of clinical relevance: The findings may guide surgeons in their operative indications and clinical decision making as well as guide future biomechanical research on periarticular implant effects.

Introduction: Injury-related readmissions related to an index injury admission impose significant burden on patients, families, and health systems. Understanding predictors of short-, medium-, and long-term injury-related readmissions can inform strategies to mitigate risk and guide early interventions. This study examines injury-related readmission patterns and predictors among transport-injured patients in Queensland, Australia.

Methods: A population-based, epidemiological data-linkage study was conducted using hospital administrative records for transport-related injury admissions between 2011 and 2021. Index admissions were identified, and subsequent injury-related readmissions were classified using time- and diagnosis-based logic. Outcomes included three time frames for readmissions: within 31-days, 90-days, and 1-year post-discharge. Parametric survival analysis with a Gompertz distribution assessed predictors of injury-related readmission, and dominance analysis quantified the relative importance of these predictors. Predictors spanned six domains: sociodemographic factors, healthcare funder, hospital characteristics, injury-specific attributes, injury mechanism, and geographic factors.

Results: Among 89,611 patients with transport-related injury admissions, 7.2% were readmitted for injury-related conditions within 31 days, 10.5% within 90 days, and 17.2% within one year. Mean time-to-readmission was 11, 25, and 92 days for the respective timeframes. Motor vehicle crashes were the most common transport-related injury mechanism, but had the lowest injury-related readmission rates compared to bicycle, motorcycle, and pedestrian injuries. Dominance analysis indicated that injury characteristics, particularly nature of injury, were the strongest predictors of injury-related readmission, with nature, body region and injury mechanism collectively explaining 67.5% to 83.2% of variation across timeframes.

Conclusion: Injury-related readmissions after transport-related injury occur most frequently within the first month post-discharge but persist up to one year. Injury characteristics dominate predictive influence, suggesting that interventions targeting these factors may reduce both short- and long-term injury-related readmission risk. These findings highlight opportunities for tailored discharge planning and early intervention strategies to alleviate patient and system burden.

Background: Major trauma centres generally deliver better outcomes than non-specialist centres, but whether this association holds true in New Zealand, a country with challenging geography and a dispersed population, is uncertain.

Aims: The aim of this study was to determine whether definitive care at a tertiary trauma hospital compared with a regional (non-tertiary) hospital was associated with improved survival in patients with major trauma in New Zealand. We also aimed to identify factors that predict transfer from a regional hospital to a tertiary centre.

Methods: A registry-based cohort study of adults with major trauma was conducted using data from the New Zealand Trauma Registry. All patients who were in a tertiary hospital at any time during their hospitalisation were considered to have received definitive care in a tertiary centre. The primary outcome was in-hospital mortality during the index hospitalisation episode (including where a hospitalisation episode included care in multiple hospitals). Secondary outcomes were 30 and 90-day mortality, requirement for secondary transfer, and discharge destination. Multivariable logistic regression analysis was used to assess the association between definitive care hospital level and in-hospital mortality, and to identify factors associated with secondary transfer.

Results: 10,001 major trauma patients were identified, with inpatient case fatality rate of 11.1% (regional hospitals 12.7%, tertiary hospitals 10.5%; P = 0.001). After risk adjustment, definitive care at a tertiary trauma hospital was associated with substantially lower odds of in-hospital death compared with regional hospitals (adjusted odds ratio 0.68 [95% CI, 0.57-0.82]; P < 0.001). Factors associated with secondary inter-hospital transfer included intubation, injury due to falls, Māori ethnicity, higher injury severity, and younger age.

Conclusion: Definitive care provided at a tertiary trauma hospital was associated with decreased odds of mortality in major trauma patients in New Zealand, indicating the importance of improving equity of access to specialised trauma care for patients suffering from serious injuries.

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.