Injury最新文献

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.

Background: Surgical stabilization of rib fractures (SSRF) has been associated with improved pain scores, fewer ventilator days, lower rates of ventilator-associated pneumonia and tracheostomy, shorter hospitalization, and reduced mortality. RibScore is a 6-point scoring system using chest wall injury radiographic data to predict adverse pulmonary outcomes (APOs). This study examines the incidence of APOs using RibScore criteria, hypothesizing the incidence of APOs decreases after SSRF.

Methods: A single-institution retrospective review was performed for adult SSRF patients at a Level I trauma center between 1/2017 and 4/2023. Basic demographics were obtained. CT imaging was reviewed, and each patient was given a score based on RibScore criteria. Our primary outcome was incidence of adverse pulmonary outcomes (pneumonia, respiratory failure, need for tracheostomy) stratified by RibScore. The Mantel-Haenszel test for trend was used to create a linear trend between RibScore and APOs for patients who underwent SSRF. Rates of APOs after SSRF were compared to the original APOs for each RibScore.

Results: A total of 452 patients were included in the study. There was an increase in rate of tracheostomy with increasing RibScore, which was statistically significant on linear-by-linear association (p = 0.003). Similar results were demonstrated for rate of pneumonia (p < 0.001) as well as rate of respiratory failure (p < 0.001). When comparing our SSRF patients to the original RibScore adverse pulmonary outcomes, there was a significant decrease in incidence of tracheostomy (p = 0.003), pneumonia (p < 0.001), and respiratory failure (p < 0.001).

Conclusion: In this cohort, SSRF was associated with lower adverse pulmonary outcome rates across RibScore strata within our center. RibScore supports risk stratification and shared decision making. Historical comparisons are descriptive and cannot establish causality.

Level of evidence: Level IV, therapeutic/care management.

Background: Needle thoracostomy (NT) is a frontline intervention for suspected tension pneumothorax in prehospital trauma care. The necessity for intervention in patients with relative indications is unclear, and locoregional protocols guiding NT placement by prehospital personnel vary. This study aims to identify factors associated with a positive response to NT and how often objective measures are utilized to prompt intervention, which may help better define indications for the procedure.

Methods: A retrospective review of adult trauma patient who received prehospital needle decompression was performed utilizing the trauma registry database from a level 1ACS accredited trauma center in Omaha, Nebraska. A positive response was defined as increased oxygen saturation by 10 %, increased systolic blood pressure by 10 mmHg, improved ventilation or breath sounds, or return of spontaneous circulation.

Results: A total of 214 patients were included, with an overall mortality rate of 52 % of which 144 (68 %) sustained blunt trauma and 67 (32 %) penetrating trauma. Mortality was 49 % for blunt trauma and 60 % for penetrating trauma (p = 0.182). Only 63 patients (30 %) responded to NT with an improvement in clinical parameters. The most common indication(s) for NT was documented as absent/reduced breath sounds (n = 118, 55 %), CPR (n = 79, 37 %), and hypoxia (n = 40, 19 %). After excluding patients with CPR en route (n = 135/214, 63 %), positive NT response increased to 48 % and overall mortality rate decreased to 26 %. There was no significant change in systolic blood pressure (mean difference: 0.3 mm Hg, 95 % CI:4.8-5.3, p = 0.910) or heart rate (-1.1 bpm, 95 % CI:5.8-3.6, p = 0.650) post-decompression. The incidence of hypoxia decreased from 68 % to 48 % (p < 0.001). Complications were identified in 14 % of patients and one patient did have a needle inserted into the heart, required a cardiac operation, and had subsequent anoxic brain injury.

Conclusions: This study highlights the low success rates of prehospital NT, with the majority of procedures being performed based on subjective indicators. Prehospital protocols should be refined by incorporating objective criteria, such as confirmed hypoxia, to better identify patients who may benefit from NT.

Background: Significant inter-hospital variation in potentially low-value operative management of blunt solid organ injuries (SOI) has been observed but data on the impact on patient outcomes is lacking. Our primary objective was to estimate the association between potentially low-value operative management of blunt SOI and hospital mortality, complications, and length of stay (LOS). A secondary objective was to identify determinants, independent of patients' health status on arrival.

Methods: We conducted a retrospective cohort study using the National Trauma Data Bank (2016-2019). We included adults admitted with blunt SOI eligible for nonoperative management (grade I-IV spleen/liver and grade I-III kidney, hemodynamically stable, no blood products within 6 hours). We used propensity scores to generate adjusted odds ratios (OR) of mortality and complications and geometric mean ratios (GMR) of LOS.

Results: We included 62,601 adults, of whom 1,683 (2.7%) had potentially low-value operative management. Adjusted ORs were 1.92 (95% CI 1.25-2.96) for mortality and 2.39 (1.99-2.87) for complications. The adjusted GMR was 1.52 (1.38-1.68) for LOS. Low-value operative management was more frequent in males, White non-Hispanics versus African Americans, Medicaid versus private insurance, and American College of Surgeons (ACS) level II/III and state-designated hospitals versus ACS level I.

Conclusions: In this retrospective cohort study, potentially low-value operative management of SOI was infrequent but was associated with increased mortality, complications, and LOS and was influenced by sex, race and ethnicity and insurance status. Results suggest that interventions designed to reduce low-value operative management may improve patient outcomes.

Background: Electric bicycles (e-bikes) are becoming increasingly popular, offering higher speeds compared to traditional pedal bicycles. Despite their growing use, there is limited data on the epidemiology of e-bike related injuries in the pediatric population. Specifically, previous studies have not adequately explored the injury circumstances regarding e-bikes, particularly concerning loss of control due to speed. This study aims to assess the patterns and outcomes of e-bike injuries in children, hypothesizing that speeds higher than 20 miles per hour (MPH) result in more internal injuries necessitating hospital admission.

Methods: This retrospective cross-sectional study analyzed data from the National Electronic Injury Surveillance System, specifically targeting pediatric ages 0-18 e-bike injuries recorded between 2019 and 2023. We utilized natural language processing techniques to extract narratives from the database, identifying words related to the circumstances of injury, and distinguishing between speed-related incidents vs. non-speed-related incidents. The cohort was divided into two groups based on the identified cause: injuries due to increased speed and injuries attributed to other causes. We then conducted bivariate analyses to compare the characteristics and outcomes between these groups, focusing on the type of injury, its severity, and the need for hospital admission.

Results: A national estimate of 15,121 pediatric patients with injuries related to e-bikes (79.7% males and 71.3% adolescents aged 13-18) were identified. Injuries attributed to speed were associated with a higher incidence of head, neck, or facial injuries (49.1%¦vs 28.7%) compared to those resulting from other causes. A greater proportion of children with speed-related injuries sustained internal organ injuries (24.1%¦vs. 10.4%) and were admitted to the hospital (7.3%¦vs.4.7%). Of those injuries specified as "internal" 96.7% were head and neck injuries compared to 3.3% other anatomic sites. Over the five-year study period, the frequency of e-bike injuries showed a sharp increase, with 4.18% occurring in 2019 and 49.8% in 2023.

Conclusion: Pediatric e-bike injuries have increased in frequency and can be severe, requiring hospitalization. The findings highlight the risks associated with speeds higher than 20 MPH on e-bikes and the need for targeted safety measures and legislation especially related to prevention of head injuries. Future research should focus on the effectiveness of safety interventions, including helmet usage and speed control features on e-bikes.

Type of study: retrospective cross-sectional study.

Objective: Helmets play a critical role in preventing and reducing the severity of head injuries in high-risk sports. Understanding the factors influencing equestrian helmet use and safety perceptions is needed to optimise injury prevention strategies.

Methods: In this cross-sectional study of 596 equestrian participants aged ≥12 years, we assessed helmet use, factors influencing helmet purchase decisions, and perceptions of helmet safety. Chi square tests and regression models examined differences by age, professional status, jumping versus non-jumping disciplines and concussion history.

Results: Helmet use whilst riding was high (96 % participants). A high proportion of helmets used for competition (97 %) met at least one safety standard, however this was lower for recreational use (65 %). Younger equestrians (aged 12-44 years) and those who had not experienced a concussion were more likely to rank price as the most important factor for helmet purchase decision making. There were no differences by jumping or non-jumping equestrian disciplines or professional status. Older age and being female were independently linked with higher perceptions of helmet safety in the regression model (p = 0.01).

Conclusion: Safety messages need to focus on improving understanding of helmet standards and the reasoning behind safety recommendations to help reduce the injury risk in equestrian sports, particularly targeting adolescents/young adults.

Introduction: The global trauma burden disproportionately affects low- and middle-income countries(LMICs), which lack robust emergency medical services(EMS). The Global Prehospital Consortium determined Tier-1 EMS response intervals are a priority for investigation. On-scene response intervals for professional ambulance-driven Tier-2 EMS vary by density of centralized ambulance dispatch sites per population, requiring costly infrastructure to improve response times. Community bystander-driven (Tier-1) systems are less costly with diffuse and non-centrally dispatched responders. Therefore, we hypothesized Tier-1 EMS response intervals to emergencies are not distance-related, due to the inherent diffusion of Tier-1 responders.

Methods: In 2016, Tanzania Rural Health Movement launched a Tier-1 lay first responder(LFR) program in Tanzania integrated with Beacon, a mobile emergency medical dispatch(EMD) platform. LFRs were provided with a two-day training course. Chief complaints, diurnal emergency variation, and response/triage/encounter intervals were prospectively recorded for analysis. GIS software (ArcGIS Pro 2.8) evaluated encounter latitude/longitude and distance from Mwanza city center, compared with response interval, using a logarithmic distribution for correlational analysis.

Results: 1273 entries were prospectively catalogued (2017-2024). 60 encounters lacked ≥67 % data compliance, 136 lacked GPS coordinates, and 89 geographic/time outliers were excluded, leaving 988 encounters for analysis (77.6 %). Of chief complaints, 81.0 % were road traffic injury-related. Median dispatch to on-scene arrival interval = 1 minute 4 seconds (IQR:36s-5m9s) and median on-scene arrival to triage decision interval = 1 minute 2 seconds (IQR:37s-2m32s) (n = 988). There was no correlation between log (response time interval) and log (distance from Mwanza center) (r = 0.028, p = 0.380) (n = 1012).

Conclusions: In this community-based EMS model, response times were rapid and not associated with geographic distance, highlighting the effectiveness of decentralized Tier-1 systems when combined with mobile dispatch technology. These findings support the scalability of low-cost, bystander-driven EMS networks in LMICs without reliance on traditional costly dispatch infrastructure, offering a promising strategy to address the global trauma burden.

Individuals experiencing homelessness are known to be at an increased risk of poor health outcomes compared to those of relatively higher socioeconomic statuses. Specifically, a major cause of morbidity for people experiencing homelessness is traumatic injury. While poor outcomes after a traumatic injury for people experiencing homelessness is well documented in the American context, such literature for the Canadian context remains sparse. In this retrospective cohort study of 4551 trauma patients admitted at a Level 1 trauma center in Montreal, Canada, from 2016-2019 (inclusive), we determined the trauma outcomes of patients experiencing homelessness. We found that the outcomes between homeless and non-homeless trauma patients to be similar, but experiencing homelessness was associated with a 71 % increase in the odds of intubation. Healthcare coverage may have the potential to mitigate some of the adverse effects of a low socioeconomic status.

Background: Traumatically injured patients who are detained by law enforcement have variable disposition possibilities that may be unclear to providers. This creates difficulties in discharge planning, and may contribute to disparities in outpatient care. The objective of this study was to evaluate emergency department (ED) utilization, readmissions, and follow-up for traumatically injured patients discharged to jail compared to those discharged to home.

Methods: This was a retrospective review of traumatically injured patients at a Level 1 trauma center from 2015 - 2022. All patients discharged to jail were propensity matched 1:1 to a subset of patients discharged to home. The match was based on age, gender, race, mechanism of injury, and Injury Severity Score. The primary outcome was ED utilization within 60 days. Secondary outcomes were unplanned readmissions and attendance at trauma-related follow-up appointments. Outcomes were compared between the two groups.

Results: There were 392 matched pairs. Patients discharged to jail were more likely to visit the ED compared to home patients (25 % vs 18 %, OR 1.46, 95 % CI 1.02 - 2.10, p = 0.030). There were no differences in unplanned readmissions (6 % vs 7 %, OR 0.86, 95 % CI 0.48 - 1.53, p = 0.579) between the two groups. Patients discharged to jail were more likely to visit the ED with concerns regarding obtaining their discharge prescriptions (19 % vs 1 %, p < 0.001), and 30 % (n = 7) of these patient readmissions were due to the jail not being able to accommodate their medical cares. A total of 28 % of patients discharged to jail had no trauma-related ambulatory follow-up compared to 15 % of home patients (OR 2.33, 95 % CI 1.59 - 3.49, p < 0.001).

Conclusion: Patients discharging to jail face fragmented transitions of care which creates barriers in outpatient healthcare engagement. They are more likely to visit the emergency department, and are less likely to have appropriate trauma related follow-up care. Targeted interventions are necessary to support this patient population to improve outpatient care after injury.