Journal of Trauma and Acute Care Surgery最新文献

{"title":"Does frailty predict readmission and mortality in diverticulitis? A nationwide analysis.","authors":"Omar Hejazi, Christina Colosimo, Muhammad Haris Khurshid, Collin Stewart, Mohammad Al Ma'ani, Tanya Anand, Francisco Castillo Diaz, Lourdes Castanon, Louis J Magnotti, Bellal Joseph","doi":"10.1097/TA.0000000000004707","DOIUrl":"10.1097/TA.0000000000004707","url":null,"abstract":"<p><strong>Introduction: </strong>Diverticulitis is a major health concern in the United States affecting up to 25% of elderly population. It is unknown if frailty increases the risk of recurrent diverticulitis. The aim of our study is to identify the association between frailty and recurrence of diverticulitis.</p><p><strong>Methods: </strong>We performed a retrospective analysis of the Nationwide Readmissions Database 2019 and included geriatric (65 years or older) patients admitted for acute complicated diverticulitis (ACD) who were managed nonoperatively between January and June and had a 6-month follow-up. Patients were stratified into nonfrail, prefrail, and frail groups using the five-factor modified frailty index. Primary outcome was readmission due to ACD or acute uncomplicated diverticulitis (AUD) at 1 and 6 months after the admission. Secondary outcome was mortality. Multivariable regression analysis was performed to identify the predictors of recurrent diverticulitis and outcomes.</p><p><strong>Results: </strong>We identified 10,807 patients (nonfrail, 1,953; prefrail, 4,616; frail, 4,238). No differences were found between the groups in readmissions for recurrent ACD and AUD at 1 month after discharge. However, nonfrail patients and prefrail had higher rates of ACD ( p = 0.009) and AUD ( p < 0.001) at 6 months after index admission. Frail patients had higher mortality on index admission ( p < 0.001) and at 6 months ( p < 0.001). On multivariable regression analyses, frailty was a predictor of mortality on index (adjusted odds ratio, 1.99; p < 0.001) and readmissions (adjusted odds ratio, 3.05; p < 0.001).</p><p><strong>Conclusion: </strong>Frailty was not identified as a predictor of developing recurrent diverticulitis; however, frail patients are at increased risk of mortality once they develop diverticulitis. Optimal management for frail patients with diverticulitis must be defined to improve outcomes.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"605-610"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age matters: A Secondary Analysis of Endothelial Biomarkers in the Prehospital Tranexamic Acid for Traumatic Brain Injury Trial.","authors":"Tanya Anand, Scott Mcloud, Lindsay Loss, Karen Minoza, Phillip Jenkins, Susan Rowell, Jack McLean, Bellal Joseph, Martin Schreiber","doi":"10.1097/TA.0000000000004582","DOIUrl":"10.1097/TA.0000000000004582","url":null,"abstract":"<p><strong>Background: </strong>Injured older adults account for nearly 25% of trauma admissions nationwide with increased morbidity and mortality compared with younger adults. Endothelial dysfunction has been associated with poor outcomes in trauma patients. We hypothesized that posttraumatic endothelial changes in older versus younger adult trauma patients will be different with worse outcomes in older adults.</p><p><strong>Methods: </strong>This is a retrospective secondary analysis of the \"Tranexamic Acid (TXA) in Traumatic Brain Injury\" prehospital database (2015-2017). We studied patients with admission endothelial biomarkers: intercellular adhesion molecule 1, angiotensin 1, thrombomodulin, vascular cell adhesion molecule 1 (VCAM 1), angiotensin 2, syndecan-1, and thrombospondin. We divided patients into age quartiles and compared the oldest quartile (older age [OA] group) with the three youngest quartiles (younger age [YA] group). In-hospital, discharge, and mortality outcomes were compared. Significance was set at p < 0.05.</p><p><strong>Results: </strong>A total of 436 patients were included. The mean age in OA group was 66 years (55-88 years, n = 108). The YA mean age was 30 years (15-54 years, n = 328). There was no difference between OA and YA in rates of blunt trauma (98.1% vs. 96.3%, p = 0.61), head abbreviated injury scale (mean, 2.83 vs. 2.93; p = 0.582), or Injury Severity Score (mean, 21 vs. 19; p = 0.29). Tranexamic acid dosing was not different between cohorts ( p = 0.571). Overall, the OA group had higher thrombomodulin (median, 693.3 vs. 592.9 pg/mL; p = 0.0008), VCAM 1 (median, 70,852 vs. 59,738 pg/mL; p = 0.0015), and angiotensin 2 (median, 165.3 vs. 134.2 pg/mL; p = 0.005). When comparing endothelial biomarkers of OA to each YA age quartile subsets, in the 2g TXA group OA patients had significantly higher syndecan-1 levels from a subset of YA (37 to 54-year-olds, p = 0.034). In the 2g TXA group OA patients had significantly lower plasma thrombomodulin, angiotensin 2, and VCAM 1 ( p = 0.00001, p = 0.0032, and p = 0.0002, respectively) than patients in the placebo group. None of the biomarkers were independent predictors of 28-day mortality.</p><p><strong>Conclusion: </strong>Despite similar injury patterns, OA presented with higher admission endothelial plasma biomarkers. The OA patients receiving 2 g of TXA had significantly different endothelial biomarker levels versus YA group. These differences suggest that OA patients have a different baseline endothelial function prior to injury and that TXA may have a more pronounced effect on injured OA versus YA endothelium.</p><p><strong>Level of evidence: </strong>Therapeutic Care Management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"541-550"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma center performance and outcome disparities in severe childhood traumatic brain injury: A Trauma Quality Improvement Program study including a causal mediation analysis.","authors":"Joseph Piatt","doi":"10.1097/TA.0000000000004696","DOIUrl":"10.1097/TA.0000000000004696","url":null,"abstract":"<p><strong>Background: </strong>That Black children die at higher rates from traumatic injuries has been recognized for years, but race as a social construct cannot itself be a cause of death. The effect of race must be mediated.</p><p><strong>Methods: </strong>This observational, cross-sectional study was based on data from the Trauma Quality Improvement Program of the American College of Surgeons for the years 2014 through 2022. Severe traumatic brain injury was defined as an Abbreviated Injury Scale head score of 4 or greater. Exclusion criteria were age older than 18 years, transfer to another acute care facility, and discharge from a facility that treated 10 or fewer cases. The outcome was mortality. A probability of mortality was assigned to each case as a metric of injury severity. A ratio of observed to expected deaths was calculated as a metric of trauma center (TC) performance. Causal mediation analyses were performed to estimate the contributions of injury severity and TC performance to mortality disparities between Black and White children and between Hispanic and non-Hispanic White children.</p><p><strong>Results: </strong>There were 51,025 cases in the study sample. Raw mortality rates were 30.4% and 16.1% for Black and White children, respectively ( p < 0.0001), and 16.9% and 15.9% for Hispanic and non-Hispanic White children, respectively ( p = 0.0366). Injury severity mediated a 10.8% increment in the risk of mortality for Black children, and TC performance mediated another 0.4% increment. For Hispanic children, injury severity mediated a 1.2% increment in risk of mortality, and TC performance mediated a 0.4% protective effect.</p><p><strong>Conclusion: </strong>Trauma center performance accounts for a small but highly significant increment to the mortality disparity between Black and White children with severe traumatic brain injury, but as in past work, injury severity makes a much greater contribution.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiologic; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"597-604"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of healing and timing of repeat imaging after blunt cerebrovascular injury: A systematic review and meta-analysis.","authors":"Angela Li, Kevin Durr, Shannon M Fernando, Bram Rochwerg, Kenji Inaba, Walter L Biffl, Peter Glen, Maher Matar, Jacinthe Lampron, Dalibor Kubelik, Paul T Engels, Leah Rosenkrantz, Philip Dawe, Naisan Garraway, Emilie Joos, Alexandre Tran","doi":"10.1097/TA.0000000000004748","DOIUrl":"10.1097/TA.0000000000004748","url":null,"abstract":"<p><strong>Background: </strong>Blunt cerebrovascular injury (BCVI) is a nonpenetrating carotid and/or vertebral artery injury following trauma. Treatment typically involves antiplatelets or anticoagulation followed by repeat imaging. However, little is known regarding the natural history of BCVI on treatment. Therefore, we performed a systematic review and meta-analysis to summarize the healing rates at various intervals of repeat imaging.</p><p><strong>Methods: </strong>We searched Embase and Medline from inception to November 22, 2024. We included studies reporting imaging-based follow-up outcomes of adult patients with BCVI. We organized data based on injury status and summarized overall resolution, progression, stability, and worsening of BCVI at various time points and according to injury grade.</p><p><strong>Results: </strong>We included 20 studies involving 2,641 patients. Studies were predominantly retrospective in nature, originating from North America, and follow-up was primarily performed using computed tomography angiography. The median (Q1 to Q3) stroke incidence was 8.5% (5.1% to 13.1%). We demonstrate that lower-grade injury is associated with BCVI healing at follow-up imaging (pooled unadjusted odds ratio, 6.73; 95% confidence interval, 4.23-10.71, moderate certainty). In addition, we demonstrate that Grades I and II injuries demonstrated higher rates of resolution or improvement at every follow-up imaging period.</p><p><strong>Conclusion: </strong>This review demonstrates with moderate certainty that lower-grade BCVIs probably heal faster, while higher-grade BCVIs persist longer. These findings emphasize the importance of considering injury grade when determining the appropriate follow-up imaging interval.</p><p><strong>Level of evidence: </strong>Systematic Review and Meta-analysis; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"643-649"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma disparities occur upstream from hospitals: Neighborhood social vulnerability predicts incidence of various traumatic injuries but not case fatality.","authors":"Matthew T Hey, Isaac G Alty, P Tarsicio Uribe Leitz, Raina Parikh, Sarabeth Spitzer, Rachel E Wittenberg, Pooja U Neiman, John Scott, Molly Jarman, Geoffrey A Anderson","doi":"10.1097/TA.0000000000004645","DOIUrl":"10.1097/TA.0000000000004645","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a complex disease process often affecting the most vulnerable members of society. This cross-sectional study aims to identify the relationship between incidence and case fatality rate of injury with the Social Vulnerability Index (SVI), a composite score of community disparity.</p><p><strong>Methods: </strong>A convenience sample of six State Inpatient Databases from 2016, provided by the Healthcare Cost Utilization Project, was generated for patients older than 18 years with specific International Classification of Diseases, Tenth Revision , codes for external cause of injury. Individual ZIP codes were converted to census tracts, and SVI scores were assigned to each census tract divided each admission into an SVI quintile. Multivariable Poisson regression was used to assess association between incidence of traumatic events, case fatality, and SVI quintiles, adjusted for age, sex, state, and new Injury Severity Score.</p><p><strong>Results: </strong>A total of 396,209 unique hospital admissions were included in the cohort. Injury from fall was the most common trauma, occurring in 308,280 admissions (77.8%). Proportionally, the highest SVI quintile (most vulnerable) experienced the most traumatic events across all injury categories. In those who experienced assault, the highest SVI quintile had over eight times greater incidence of injury compared with the lowest quintile (incidence rate ratio, 8.92; p < 0.001). The association of higher SVI and incidence of injuries persisted across all categories after adjusting for age, sex, and state. There was no meaningful association between case-fatality rate and SVI quintile in any traumatic injury category, before or after adjustment for Injury Severity Score, except for when age adjustment was removed from the model.</p><p><strong>Conclusion: </strong>Populations from more socially vulnerable neighborhoods experience traumatic events at higher rates than those living in low SVI neighborhoods. However, community social vulnerability was not associated with a clinically significant difference in in-hospital case-fatality rate, except when age adjustment was removed from the model. Understanding how the most vulnerable populations experience traumatic events differently can inform policy and guide targeted upstream preventative measures within vulnerable communities.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiologic; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"571-579"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing safety and efficacy: Assessment of a weight-based, anti-Xa-guided enoxaparin venous thromboembolism prophylaxis dosing strategy for traumatic brain injury patients.","authors":"Steven Atallah, Benjamin J Lee, Andy Lo, Christopher J Limbo, Jefferson W Chen, Jeffry Nahmias","doi":"10.1097/TA.0000000000004701","DOIUrl":"10.1097/TA.0000000000004701","url":null,"abstract":"<p><strong>Background: </strong>Patients with traumatic brain injury (TBI) with intracranial hemorrhage (ICH) are at high risk for venous thromboembolism (VTE) but are also prone to hemorrhagic progression. The efficacy and safety of weight-based, anti-Xa-guided enoxaparin dosing for patients with ICH are unknown. Therefore, this study aimed to compare fixed chemoprophylaxis versus weight-based, anti-Xa-guided enoxaparin dosing in the setting of ICH, hypothesizing reduced VTE incidence with similar ICH progression with weight-based, anti-Xa-guided dosing.</p><p><strong>Methods: </strong>This was a retrospective pre-post, quasi-experimental study conducted at a single, academic, Level I trauma center. Adult TBI patients admitted from December 2017 to May 2023 with ICH identified on computed tomography imaging who received at least 24 hours of chemoprophylaxis were included. A weight-based, anti-Xa-guided enoxaparin arm was compared with fixed doses of enoxaparin (40 mg) daily or unfractionated heparin (5,000 units) two to three times daily. Treatment groups were compared using a 1:1 propensity score matching (PSM), which matched for demographics and injury profile.</p><p><strong>Results: </strong>Of 831 included patients, 252 PSM cohorts were compared. A significantly lower incidence of VTE was observed in the anti-Xa-guided cohort (2.4% vs. 6.4%; p = 0.029), while radiographic ICH progression was equivalent between the two cohorts (4.4% vs. 4.4%; p = 0.99). A subgroup PSM analysis comparing 208 patients each from the anti-Xa-guided versus enoxaparin-only control cohort also demonstrated a significantly lower incidence of VTE with the anti-Xa-guided treatment (1.4% vs. 5.8%; p = 0.032) with no difference in radiographic ICH progression (4.3% vs. 2.4%; p = 0.28).</p><p><strong>Conclusion: </strong>Weight-based, anti-Xa-guided enoxaparin dosing was associated with reduced VTE incidence without increased ICH progression in TBI patients with existing ICH.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"551-559"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and management of gastrointestinal hemorrhage: What you need to know.","authors":"Michael Martyak, Alexa Soult, L D Britt","doi":"10.1097/TA.0000000000004599","DOIUrl":"10.1097/TA.0000000000004599","url":null,"abstract":"<p><strong>Abstract: </strong>Acute gastrointestinal (GI) hemorrhage is a common cause for hospital admission that requires prompt diagnosis and multidisciplinary management to optimize clinical outcomes. Acute gastrointestinal bleeding (GIB) includes both upper and lower GI tract sources with an extensive list of differential pathologies. This review provides a systematic approach to both upper and lower GIB management, emphasizing initial resuscitation, stabilization, diagnostic evaluation to identify the source, and treatment modalities. Endoscopy remains the cornerstone for diagnostic and interventional purposes, significantly reducing the need for surgical procedures. However, lower GIB and severe or refractory cases may necessitate additional imaging and interventions, including surgical management. Integrating clinical guidelines, evidence-based strategies, and individualized care, this review delineates what you need to know to diagnose and manage acute GI hemorrhage.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"491-503"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based, cost-effective management of large bowel obstruction: An algorithm of the Journal of Trauma and Acute Care Surgery Emergency General Surgery Algorithms Work Group.","authors":"Ali Salim, Manuel Castillo-Angeles, Walter L Biffl, Todd W Costantini, Jose Diaz, Kenji Inaba, David H Livingston, Lena M Napolitano, Robert Winchell, Raul Coimbra","doi":"10.1097/TA.0000000000004743","DOIUrl":"10.1097/TA.0000000000004743","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"514-517"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enteral protein supplementation in critically ill trauma and surgical patients: A single-center randomized clinical trial.","authors":"Grant E O'Keefe, Siobhan P Brown, Marilyn M Shelton, Qian Qiu, Erika K Bisgaard, Ida M Wilson, Jamie L Robinson, Daniel J Roubik, Alex Malloy, Susanne May","doi":"10.1097/TA.0000000000004745","DOIUrl":"10.1097/TA.0000000000004745","url":null,"abstract":"<p><strong>Background: </strong>Critically ill trauma and surgical patients are highly catabolic, with expected high protein needs. However, there is uncertainty regarding the amount of protein required to optimize their outcomes. We conducted a single-center, randomized clinical trial to test the hypothesis that supplementing enteral protein intake would improve outcomes.</p><p><strong>Methods: </strong>Between November 15, 2016, and November 26, 2021, critically ill trauma and surgical patients were randomized either to a treatment arm aimed to deliver 2 g/kg/d of enteral protein or to standard nutritional care. Data were collected and subjects were followed until hospital discharge. Serum transthyretin concentration 14 to 21 days following intensive care unit admission and ventilator-free days were prespecified endpoints.</p><p><strong>Results: </strong>We randomized 500 subjects who were predominantly male (77%), suffered traumatic injuries (86%), and had a median age of 47 years. Those in the treatment arm received twice the amount of protein than those in the control arm (1.2 ± 0.65 g/kg/d vs. 0.6 ± 0.39 g/kg/d averaged over the first 7 days of hospitalization; p < 0.001). We observed no significant difference in mean transthyretin concentrations (difference of means, 0.8 mg/dL; 95% confidence interval, -1.3 to 2.8; p value = 0.46) or ventilator-free days (difference of means, -1.1; 95% confidence interval, -2.8 to 0.6; p value = 0.21). Participants receiving supplemental protein had higher blood urea nitrogen concentrations and were more likely to require reintubation.</p><p><strong>Conclusion: </strong>In this clinical trial of critically ill trauma and surgical patients, protein supplementation did not improve outcomes but was associated with increased complications.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"635-642"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and meta-analysis of efficacy of helmet use and helmet laws to reduce mortality and cervical spine injury in adult motorcycle riders: A practice management guideline from the Eastern Association for the Surgery of Trauma.","authors":"Asanthi M Ratnasekera, Sirivan S Seng, Stuart K Gardiner, Caroline Butler, Anna Goldenberg-Sandau, Ning Lu, Hiba Abdel Aziz, Rachel D Appelbaum, Hassan Mashbari, Shabnam Hafiz, Sharfuddin Chowdhury, Hahn Soe-Lin, John M Reynolds, Amanda L Teichman, Susan Kartiko, Elinore J Kaufman, Patrick Murphy, Lisa Kodadek, Rishi Rattan","doi":"10.1097/TA.0000000000004607","DOIUrl":"10.1097/TA.0000000000004607","url":null,"abstract":"<p><strong>Background: </strong>Motorcycle crash fatalities remain a significant public health concern. Traumatic brain injury is a leading cause of death following motorcycle crash. We aim to provide evidence-based guidelines pertaining to helmet use and helmet laws with respect to important outcomes including mortality, cervical spine injury, and discharge disposition.</p><p><strong>Methods: </strong>An evidence-based systematic review was performed to answer the following Population, Intervention, Comparator, Outcomes (PICO) questions: PICO 1-Should adult motorcycle riders wear helmets or not wear helmets to improve mortality, brain injury-related mortality, cervical spine injury, and discharge disposition from the hospital? PICO 2-Should motorcycle universal helmet laws (UHLs) or no UHLs be enacted to improve mortality, brain injury-related mortality, cervical spine injury, and discharge disposition from the hospital? An academic medical librarian searched Medline, Cochrane CENTRAL, CINAHL, Embase, Engineering Village, Health and Safety Science Abstracts, Scopus, SPORTDiscus, TRID, the VHL Regional Portal, and Elsevier. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used to assess the quality of the evidence and create recommendations. The working group reached consensus on the final evidence-based recommendations. The study was registered in PROSPERO (CRD42020172705).</p><p><strong>Results: </strong>A total of 28 studies were identified for analysis for PICO 1, and 10 studies were identified for PICO 2. Helmet use was associated with a lower incidence of mortality (odds ratio, 0.48; 95% confidence interval, 0.41-0.56; p < 0.001) and lower incidence of cervical spine injury (odds ratio, 0.66; 95% confidence interval, 0.58-0.76; p < 0.001). Although a meta-analysis for PICO 2 was not possible because of significant methodological heterogeneity, the vast majority of studies demonstrated large improvements in outcomes with a UHL. Overall certainty of evidence was deemed low for PICO 1 and PICO 2 because of risk of bias.</p><p><strong>Conclusion: </strong>We strongly recommend that individual motorcycle riders wear helmets and that universal helmet legislation be enacted and enforced to decrease mortality, to decrease the incidence of cervical spine injury, and to improve discharge disposition from the hospital.</p><p><strong>Level of evidence: </strong>Systematic Review and Meta-analysis; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"650-663"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}