Journal of Trauma and Acute Care Surgery最新文献

{"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":"https://doi.org/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>Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","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":"Letter re: \"The use and timing of angioembolization in pediatric blunt liver and spleen injury\".","authors":"Nikita Nunes Espat, Nickolas Hernandez, Adel Elkbuli","doi":"10.1097/TA.0000000000004495","DOIUrl":"https://doi.org/10.1097/TA.0000000000004495","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285111","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":"The A+ criteria for pediatric blunt cerebrovascular injury: An ATOMAC+ multicenter study.","authors":"Todd A Nickoles, James W Eubanks, Ruth A Lewit, Rumana Siddique, David M Notrica, Rachael L Stottlemyre, Mark Ryan, Jeremy Johnson, Robert Todd Maxson, Jessica A Naiditch, Karla A Lawson, Regan Williams","doi":"10.1097/TA.0000000000004686","DOIUrl":"https://doi.org/10.1097/TA.0000000000004686","url":null,"abstract":"<p><strong>Background: </strong>Blunt cerebrovascular injury (BCVI) is rare but significant among injured children. Current BCVI screening criteria lack adequate diagnostic accuracy for pediatrics. This preplanned secondary analysis identified common risk factors for BCVI among a multicenter cohort of pediatric trauma centers within the ATOMAC+ Pediatric Trauma Research Network (APTRN) and derived a new set of screening criteria.</p><p><strong>Methods: </strong>A prospective, multi-institutional observational study of children <15 years old who sustained blunt trauma to the head, face, or neck (AIS > 0) who presented at one of six level I pediatric trauma centers over a 3-year period was conducted. Patients were prospectively screened using the Memphis criteria to determine need for diagnostic imaging. Additional physical and diagnostic examination findings, risk factors, and screening data were also collected for analysis.</p><p><strong>Results: </strong>A total of 2,283 patients were enrolled at the six trauma centers and 25 (1.09%) were diagnosed with a BCVI. Patients without two-week follow up were excluded from analysis, leaving 1327 patients for analysis. Many injuries predicted BCVI on univariate analysis in the study population (p < 0.0001). When examined with a multivariable logistic regression model, temporal fractures, sphenoid fractures, orbital roof fractures, fractures of C1-4, and/or ligamentous injuries of the cervical spine predicted BCVI in pediatric trauma patients with blunt head, face, or neck injuries. These criteria are used to define a set of screening criteria that are specific to pediatrics and practical to implement.</p><p><strong>Conclusion: </strong>The A+ criteria for BCVI screening among pediatric trauma patients suggests a high sensitivity and specificity by including significant injuries and symptoms. These predictors of BCVI may be used to identify pediatric blunt trauma patients at high risk for BCVI while limiting radiation exposure to children.</p><p><strong>Level of evidence: </strong>(Diagnostic Test/Criteria); Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285114","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":"Letter to the editor: Trauma care and its financing around the world.","authors":"Shailvi Gupta, Amila Ratnayake, Ian D Civil","doi":"10.1097/TA.0000000000004605","DOIUrl":"https://doi.org/10.1097/TA.0000000000004605","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285112","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":"Proof of concept of an Automated Battlefield Trauma System for large-scale combat operations.","authors":"Jay B Baker, John Blumhorst, Simon J Strating, Heather Holub, Matthew Perry, Mason H Remondelli, Ryan Leone, Stacy A Shackelford, Jennifer M Gurney","doi":"10.1097/TA.0000000000004675","DOIUrl":"https://doi.org/10.1097/TA.0000000000004675","url":null,"abstract":"<p><strong>Background: </strong>Large-scale combat operations (LSCO) generate high casualty volumes, challenging battlefield trauma care and necessitating a synchronized approach that integrates medical operations with warfighting functions. Existing casualty management tools, such as the Medical Planners Toolkit and Joint Medical Planning Tool, provide static estimates and lack predictive capabilities for evacuation and medical resupply. The Automated Battlefield Trauma System (ABTS) was developed to address these limitations by automating casualty categorization, resource estimation, and Medical Common Operating Picture reporting.</p><p><strong>Methods: </strong>Tested during the US Army I Corps' Warfighter Exercise (WFX) 25-02, ABTS used casualty data derived from the Russo-Ukrainian conflict to estimate critical resource needs for medical units across different echelons. Integrated with Warfighter Simulation data, ABTS provided automated dashboards to track casualty categories, estimate died-of-wounds rates, and predict resource shortages. Initially relying on Excel-based dashboards, late-stage integration with Palantir's Maven Smart Systems enabled enhanced real-time data visualization and decision support for commanders.</p><p><strong>Results: </strong>Key takeaways from the proof of concept include the following: (1) automation significantly improves casualty care management in LSCO; (2) ABTS enhances predictive logistics for evacuation and medical resupply; (3) it serves as a critical risk management tool for commanders; and (4) integration with warfighting functions is essential for operational effectiveness. While successful, future iterations must refine casualty modeling, enhance data integration with emerging artificial intelligence and machine learning capabilities, and expand interoperability with Joint and allied forces.</p><p><strong>Conclusion: </strong>The Automated Battlefield Trauma System demonstrated its potential to transform battlefield casualty management by leveraging automation and predictive analytics. Continued development will refine its capabilities, improve real-time data integration, and ensure its applicability across military operations, enhancing survivability and operational efficiency in LSCO environments.</p><p><strong>Level of evidence: </strong>Proof of Concept; Level V.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310094","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":"Prognosis, risk factors, and scoring model of patients resuscitated from traumatic cardiac arrest: A multicenter observational study in Japan.","authors":"Narong Kulvatunyou, Natasha Keric","doi":"10.1097/TA.0000000000004666","DOIUrl":"https://doi.org/10.1097/TA.0000000000004666","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285113","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":"Waiting to initiate venous thromboembolism prophylaxis increases the incidence of venous thromboembolism in pediatric patients with traumatic bleeding.","authors":"Erin Feeney, Katrina M Morgan, Leah Furman, Barbara A Gaines, Christine M Leeper","doi":"10.1097/TA.0000000000004670","DOIUrl":"https://doi.org/10.1097/TA.0000000000004670","url":null,"abstract":"<p><strong>Background: </strong>We aim to evaluate the relationship between timing of venous thromboembolism (VTE) prophylaxis initiation and incidence of VTE in a high-risk cohort of injured children.</p><p><strong>Methods: </strong>This is a retrospective analysis of the Acute Care Surgery Trauma Quality Improvement Program database (2020-2022). Injured children (younger than 18 years) who received blood products or underwent hemorrhage control surgery within 4 hours of arrival were included. The primary outcome was VTE (deep venous thrombosis or pulmonary embolism). Multivariable analysis assessed the relationship between timing of VTE prophylaxis and VTE, adjusting for prophylaxis agent, type of surgery, head injury severity, interfacility transfer, total 4-hour blood product administration, injury mechanism, Injury Severity Score, age, sex, and trauma center level, clustered by facility. Missing data were imputed. Subgroup analyses include age younger than 15 years.</p><p><strong>Results: </strong>Of 4,575 children included, 3,902 underwent hemorrhage control surgery, and 4,141 received blood product transfusion. In total, 185 (4%) developed VTE (n = 154 deep venous thrombosis and/or n = 45 pulmonary embolism). The VTE cohort was older (16 [15-17] vs. 16 [13-17] years), had higher Injury Severity Score (27 [19-36] vs. 25 [14-35]), and was more likely to be in shock on arrival based on shock index, pediatric age-adjusted score (75% vs. 64%). The rate of prophylaxis was 51%, with common agents being low-molecular-weight heparin (38%) and unfractionated heparin (11%). The median (interquartile range) time to initiation of prophylaxis was 2 (2-4) days. In the multivariable analysis, every 1-day delay to initiation of VTE prophylaxis was associated with 6% increase in odds of VTE (odds ratio [95% confidence interval], 1.06 [1.03-1.10]; p < 0.001). In a subset of children younger than 15 years with VTE incidence of 3%, this relationship persisted (every 1-day delay = 4% increase in odds of VTE; odds ratio, 1.04 [1.01-1.07]; p = 0.04).</p><p><strong>Conclusion: </strong>Earlier VTE prophylaxis initiation was associated with decreased odds of VTE development in this high-risk pediatric cohort, highlighting opportunities to optimize VTE prevention. Future multicenter studies regarding safety and therapeutic agent of choice are required.</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":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285116","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":"Treatment with MG53 ameliorates traumatic brain injury-associated acute kidney injury.","authors":"Marjorie R Liggett, Bowen Wang, Zaiba S Dawood, Mengxue Zhang, Guang Jin, Jessie W Ho, Meredith E Taylor, Vincent White, Indira Pla, Aniel Sanchez, Michael Caldwell, Neil L Kelleher, Baoling Liu, Daniel C Couchenour, Aleezeh Shaikh, Yonggang Yao, Ki Ho Park, Jianjie Ma, Hasan B Alam","doi":"10.1097/TA.0000000000004660","DOIUrl":"https://doi.org/10.1097/TA.0000000000004660","url":null,"abstract":"<p><strong>Introduction: </strong>Multiorgan dysfunction (MOD) after traumatic brain injury (TBI) results in increased morbidity and mortality. There is emerging evidence demonstrating TBI-induced inflammatory responses; however, the mechanisms driving TBI-induced organ injury remains unknown and understudied. MG53, a cell membrane repair protein, has been shown to reduce brain lesion size following TBI. In this study, we aimed to establish a large animal model of post-TBI MOD, determine MG53's role in renal protection following TBI, and explore a mechanistic link between endothelial cell dysfunction and post-TBI MOD.</p><p><strong>Methods: </strong>Female Yorkshire swine (n = 5/group) were subjected to controlled cortical impact TBI and randomized to receive (1) MG53 protein therapy or (2) normal saline (control). Biomarkers of acute kidney injury were compared between the groups. Kidneys were analyzed for histologic evidence of acute injury. Top-down proteomics were performed on swine plasma at various times post-TBI.</p><p><strong>Results: </strong>Control animals had a significant increase in creatinine from baseline by 6 hours post-TBI (p = 0.007), which was attenuated in the MG53-treated animals (p = 0.089). Control animals had a significant increase in plasma NGAL from baseline starting at 4 hours from baseline (p = 0.014). Animals treated with MG53 had no change in serum NGAL from baseline (p = 0.163). Histologic analysis showed protection of proximal tubular epithelial cell damage in animals treated with MG53. Proteoform data showed differential expression of apolipoprotein 1, fibrinogen β, and osteocalcin.</p><p><strong>Conclusion: </strong>Traumatic brain injury can induce distant organ damage, possibly through endothelial cell dysfunction, and treatment with a cell membrane repair protein (MG53) can protect against this injury.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310095","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":"Examining air medical transport in interfacility emergency general surgery transfers to a quaternary center.","authors":"David S Silver, Liling Lu, Vanessa P Ho, Arnav Mahajan, Sebastian Boland, Tamara Byrd, Kevin Li, Jamison Beiriger, Francis X Guyette, Andrew B Peitzman, Matthew D Neal, Joshua B Brown","doi":"10.1097/TA.0000000000004672","DOIUrl":"https://doi.org/10.1097/TA.0000000000004672","url":null,"abstract":"<p><strong>Background: </strong>Regionalized care has increased interfacility transfers, particularly for emergency general surgery (EGS) patients requiring urgent, specialized care. Air medical transport (AMT) provides rapid transfer with critical care capabilities and is increasingly used for EGS, but its time-saving benefits remain uncertain. This study aims to identify the population of EGS patients undergoing AMT and the distance thresholds where AMT is faster than ground transport.</p><p><strong>Methods: </strong>We conducted a retrospective cohort and analyzed EGS patients transferred to our quaternary center from January 2021 to December 2023. Geospatial analysis was used to calculate transport distances, and linear regression assessed the association between transfer time and distance, identifying the threshold where the 95% confidence interval of AMT no longer overlapped with ground transport. We stratified the analysis by weather conditions and peak traffic times.</p><p><strong>Results: </strong>We analyzed 1,713 EGS patients, with 26.4% undergoing AMT. Air medical transport patients were older and more frail and had higher in-hospital mortality rates (27.9% vs. 7.2%) compared with ground transport patients. The most common primary diagnosis for was unspecified sepsis, but AMT patients had more necrotizing soft tissue infections and gastrointestinal bleeds. Air medical transport became faster than ground transport at a threshold of 5.7 miles, increasing to 7.2 miles during adverse weather and 9.1 miles during peak traffic. A random-forest model identified peak traffic and patient sequential organ failure assessment (SOFA) score as key factors influencing AMT use. Sensitivity analyses showed that including transport priority and year as interaction terms increased the distance thresholds to 17.4 miles and above.</p><p><strong>Conclusion: </strong>This is the first study to examine AMT practice patterns in EGS and quantify distance thresholds for transport efficiency. Total transfer time and choice of transport mode are significantly influenced by weather conditions and peak traffic, highlighting the need data-driven triage protocols. Such protocols will improve timely decision making and optimize patient transfers.</p><p><strong>Level of evidence: </strong>Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266497","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":"Plasminogen supplementation improves lysis of inflammatory retained traumatic hemothorax.","authors":"Elizabeth R Maginot, Flobater I Gawargi, Ernest E Moore, Collin M White, Grace E Volk, Trace B Moody, Kyle S Sextro, Dylan Hiser, John F Tierney, Olabisi O Sheppard, Charity H Evans, Emily Cantrell, Andrew J Kamien, Gina D Lamb, Miguel Matos, Jessica Veatch, Maddie R Cloonan, James G Chandler, Hunter B Moore, Peter K Moore, Angela Sauaia, Isabella M Bernhardt, Michael B Yaffe, Zachary M Bauman, Reynold Henry, Christopher D Barrett","doi":"10.1097/TA.0000000000004687","DOIUrl":"10.1097/TA.0000000000004687","url":null,"abstract":"<p><strong>Introduction: </strong>Retained hemothorax (rHTX) occurs when blood persists in the pleural space beyond 72 hours. While initial management involves chest tube placement, failure often necessitates surgical intervention. Intrapleural fibrinolytic therapy (IPFT) with tissue plasminogen activator (tPA)/DNase is a nonoperative alternative, but failure rates remain high (>20%). Prior work in pleural infections suggests fibrinolytic failure results from plasminogen degradation by neutrophil proteases. We hypothesized that rHTX is a similarly inflamed environment where plasminogen depletion impairs fibrinolysis.</p><p><strong>Methods: </strong>Hemothorax fluid and plasma were collected from trauma patients (n = 19) at a Level 1 trauma center. Elastase antigen and plasminogen activator inhibitor 1 (PAI-1) activity were measured via enzyme-linked immunosorbent assay-based assays. Western blot assessed full-length plasminogen and degradation fragments. Turbidity clot lysis assays evaluated rHTX fibrinolytic potential +/- supplemental plasminogen. Paired t tests were performed with significance at p < 0.05.</p><p><strong>Results: </strong>Elastase levels were approximately 10-fold higher in rHTX compared with plasma (rHTX, 4.76 ± 7.83 μg/mL vs. plasma, 0.45 ± 0.37 μg/mL; p = 0.02). Western blot demonstrated low plasminogen levels in rHTX compared with plasma with evidence of inflammatory degradation. After exogenous treatment of rHTX with 330pM tPA (~1,000-fold lower than clinical doses), there was no meaningful residual PAI-1 activity. Clot lysis assays of rHTX demonstrated markedly improved time to 50% clot lysis in the presence of supplemental plasminogen (rHTX, 31.3 ± 19.2 minutes vs. rHTX-plasminogen, 21.9 ± 4.5 minutes; p = 0.03). Plasminogen activator inhibitor 1 activity, although present at baseline, was rapidly neutralized by low-dose tPA, suggesting that no clinically meaningful tPA inhibition is present in rHTX (rHTX, 48.7 ± 52.3 ng/mL vs. post-tPA-treated rHTX, 2.3 ± 0.6 ng/mL active PAI-1; p = 0.003).</p><p><strong>Conclusion: </strong>Retained hemothorax is a highly inflammatory environment with secondary plasminogen depletion that reduces fibrinolytic capacity. Plasminogen activator inhibitor 1 inhibition of tPA appears to be an unlikely mechanism of clinical IPFT failure. These findings challenge the role of IPFT for rHTX and support upfront surgical intervention. Future studies exploring plasminogen supplementation in IPFT as a therapeutic strategy for poor surgical candidates is warranted.</p><p><strong>Level of evidence: </strong>Basic Science; N/A (Basic Science).</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266498","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}