Journal of Trauma and Acute Care Surgery最新文献

{"title":"Prospective multicenter external validation of the rib fracture frailty index.","authors":"Jeff Choi, Joshua A Villarreal, Rachel Handelsman, Jacob Kirkorowciz, Ariel Knight, Arathi Kumar, Emily McNabb, Jon Perlstein, Ronald B Tesoriero, Elaina Y Tsui, Cheri White, Joseph D Forrester","doi":"10.1097/TA.0000000000004624","DOIUrl":"10.1097/TA.0000000000004624","url":null,"abstract":"<p><strong>Background: </strong>The Rib Fracture Frailty (RFF) Index is an internally validated machine learning-based risk assessment tool for adult patients with rib fractures that requires minimal provider entry. Existing frailty risk scores have yet to undergo head-to-head performance comparison with age, a widely used proxy for frailty in clinical practice. Our aim was to externally validate the RFF Index in a small-scale implementation feasibility study.</p><p><strong>Methods: </strong>Prospective observational cohort study conducted across five ACS COT-verified trauma centers. Participants included ≥18-year-old adults presenting January 1, 2021, to December 31, 2021, with traumatic rib fractures. The primary outcome was a composite outcome score comprised of three clinical factors: hospitalization ≥5 days, discharge disposition, and inpatient mortality. Proportional odds logistic regression evaluated associations of age model or RFF Index score model with composite outcome scores. Models were compared using standard discrimination and calibration metrics. Secondary analysis delineated predictive performance among patients with lower (Injury Severity Score < 15) and higher Injury Severity Score ≥ 15) injury burden.</p><p><strong>Results: </strong>Of 849 participants, 546 (64%) were male and median age was 62 years (interquartile range, 46-76 years). A one-point increase in RFF score was associated with 6% increased odds of higher composite outcome score (odds ratio [OR], 1.06; 95% confidence interval [95% CI], 1.04-1.08), while a 1-year increase in age did not show statistically significant association (OR, 1.10; 95% CI, 0.75-1.61). The RFF score had higher discrimination (OR, 0.09; 95% CI, 0.08-0.11 vs. OR, 0.06; 95% CI, 0.04-0.08; p = 0.04) and calibration performance compared with age, but on secondary analysis, higher predictive performance was limited to patients with lower injury burden. Both RFF Index and age had poor calibration for predicting patients discharged to home after hospitalization ≥5 days.</p><p><strong>Conclusion: </strong>This prospective external validation study found RFF Index may be a better alternative to age for predicting adverse outcomes among patients with traumatic rib fractures and lower overall injury burden. Staged implementation studies in accordance with clinical prediction model implementation guidelines are required to evaluate the RFF Index's clinical efficacy and guide potential adoption.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"204-211"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041650","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":"Health Diplomacy at a Time of War: Palestinian and Israeli Physicians Training Together for Advanced Trauma Life Support.","authors":"Adam Lee Goldstein, Tamer Jreis, Wajdi Bkeirat, Osnat Moskowitz, Angie Alpern, Ilan Mitchnik, Barak Feldman, Ronit Zimmer, Ronit Bar-Haim, Shachar Laks, Shachar Shimonovich, Katia Dayan, Miklosh Bala, Mordechai Shimonov","doi":"10.1097/TA.0000000000004646","DOIUrl":"10.1097/TA.0000000000004646","url":null,"abstract":"<p><strong>Background: </strong>During a war continuation of cooperative training programs for physicians from opposing sides of the conflict represents a significant and unprecedented advancement. Our program, Operating Together, aims to provide lifesaving trauma training during challenging times while also establishing a novel pathway for health diplomacy and medical peace-building.</p><p><strong>Methods: </strong>We examine Advanced Trauma Life Support courses with Palestinian and Israeli physicians training together. We compared the level of training satisfaction and the desire to work together in courses conducted prior to the outbreak of the war to courses run during the war. A longitudinal study was conducted from 10 courses; five given before (November 2022 until August 2023) and five courses during the war (January 2024 until July 2024). The participants, half Palestinian physicians and half Israeli physicians, completed an anonymous questionnaire. Descriptive and statistical analysis was conducted comparing the results from the courses before and during heightened conflict.</p><p><strong>Results: </strong>A total of 199 physicians completed 10 courses and a questionnaire between November 2022 and July 2024. Ninety-seven participants were in five courses before the outbreak of the war and 102 during the war. Fifty-one percent (n = 101) were Palestinian, 49% (n = 98) were Israeli, 28% (n = 56) were female, and 72% (n = 143) were male. During the war, there were no statistical differences regarding the desire to cooperate with health initiatives (93.7% vs. 93.5%, p = 0.954), for social events (79.1% vs. 76.8%, p = 0.716) or course satisfaction (9.1/10 vs. 8.8/10, p = 0.052).</p><p><strong>Conclusion: </strong>War did not negatively influence the attitudes of physicians from opposite sides to work together professionally or cooperate socially. Joint trauma training gives lifesaving skills during challenging times while also establishing a pathway toward medical peacebuilding and optimal regional trauma care.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"253-257"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030956","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":"Novel silica-based polymer hemostatic matrix improves vessel patency rates in a coagulopathic porcine model with penetrating arterial injury.","authors":"Lauren M Heyda, Adelle M Dagher, John A Mares, Justin D Hutzler, Patrick F Walker, Jason Radowsky, Matthew Bradley, David M Burmeister","doi":"10.1097/TA.0000000000004596","DOIUrl":"10.1097/TA.0000000000004596","url":null,"abstract":"<p><strong>Background: </strong>Traumatic hemorrhage is the leading cause of preventable battlefield death and hemostatic agents can improve survival. We compared a novel, amorphous, silica dioxide-based fiber (SBF) hemostatic matrix to the criterion standard QuikClot Combat Gauze (QCCG) in treating a junctional arterial injury in hypocoagulable swine.</p><p><strong>Methods: </strong>Vascular access was obtained in 16 anesthetized swine, and hemodilution was achieved with 50% blood exchange with saline. A 5-mm arteriotomy was made in the common femoral artery. After 30 seconds of free bleeding, SBF or QCCG was applied, and pressure was held for 5 minutes. After 1 hour of monitoring, an angiogram and movement test were performed. Samples were drawn for blood count, chemistry, blood gas and rotational thromboelastography at various time points. The artery and hindlimb were collected for histology.</p><p><strong>Results: </strong>All animals (n = 8/group) survived. Hemodilution induced significant differences in hematocrit, platelets, clot formation time, and maximum clot firmness ( p < 0.0001). There was no difference in blood counts or chemistries ( p = 0.81-0.99) between groups at euthanasia. SBF required an average of 1.25 applications compared with 1.13 for QCCG ( p > 0.99). SBF had significantly less blood loss (106.2 ± 66.6 mL) versus QCCG (189.6 ± 78.9 mL, p = 0.038). Angiography revealed patency with distal perfusion in all (8/8) SBF-treated animals. Alternatively, all QCCG-treated arteries were occluded without distal perfusion, which was statistically significant ( p < 0.01). All animals remained hemostatic after the movement test. Blinded histopathological analysis revealed only two of eight cases of tunica intimal thickening and neutrophils in the QCCG group, which was not statistically different.</p><p><strong>Conclusion: </strong>SBF and QCCG had comparable hemostatic efficacy and no difference in the number of applications, despite SBF packaging containing less material. There was no evidence of significant laboratory abnormalities at the study conclusion. Taken together, SBF may be an appropriate hemostatic agent for hemorrhagic injury and is able to maintain hemostasis following stressed movement. Its improved vessel patency suggests SBF may decrease tissue ischemia and improve limb salvage in vascular injuries.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"169-174"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764388","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":"Cost-effectiveness and clinical outcomes comparison between noninvasive ventilation and high-flow nasal cannula use in patients with multiple rib fractures.","authors":"Junsik Kwon, Timothy Allison-Aipa, Thomas Patton, Bishoy Zakhary, Bruno C Coimbra, Matthew Firek, Raul Coimbra","doi":"10.1097/TA.0000000000004629","DOIUrl":"10.1097/TA.0000000000004629","url":null,"abstract":"<p><strong>Background: </strong>Patients with multiple rib fractures often require advanced respiratory support to prevent intubation and associated morbidity. Noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) are commonly used, but direct comparisons of clinical outcomes and cost-effectiveness remain limited. This study aimed to compare NIV versus HFNC using a large, nationwide US database.</p><p><strong>Methods: </strong>This retrospective cohort study used the 2020-2021 National Inpatient Sample database to identify adult trauma patients (18-89 years) with two or more rib fractures who received either NIV or HFNC without prior intubation. To focus on isolated thoracic injuries, patients with significant injuries elsewhere (Abbreviated Injury Scale score ≥3) or who died within 24 hours were excluded. Inverse probability of treatment of weighting was used to balance patient characteristics, including demographics, comorbidities, and injury severity. Primary outcomes included mortality, tracheostomy, pulmonary complications, and intubation rates. Hospital length of stay and total costs were also assessed. Cost-effectiveness analyses were conducted with intubation avoidance as the effectiveness measure, and a willingness-to-pay threshold of US $50,000 per effectiveness unit was used.</p><p><strong>Results: </strong>After adjustment, the NIV group demonstrated significantly better outcomes compared with HFNC, including lower mortality (11.4% vs. 17.0%, p = 0.007) and tracheostomy (1.2% vs. 3.1%, p = 0.006), and fewer pulmonary complications. Although intubation rates were not statistically different (12.0% vs. 15.6%, p = 0.085), the HFNC group had longer length of stay (13 vs. 10 days, p < 0.001) and incurred higher costs (US $42,505 vs. US $32,024, p < 0.001). Cost-effectiveness analysis revealed that NIV dominated HFNC, yielding better outcomes at lower costs.</p><p><strong>Conclusion: </strong>Among patients with multiple rib fractures, NIV yielded superior clinical outcomes, shortened hospital stays, and reduced costs compared with HFNC. These findings suggest that NIV may be a more cost-effective and clinically advantageous choice.</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":"194-203"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005776","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":"Optimization of physiology in organ donors in the intensive care unit: What you need to know.","authors":"Elizabeth A Swanson, Anthony J Hayes, Darren J Malinoski","doi":"10.1097/TA.0000000000004565","DOIUrl":"10.1097/TA.0000000000004565","url":null,"abstract":"<p><strong>Abstract: </strong>Optimizing the physiology of organ donors is a critical component of preserving the option for organ donation and addressing the shortage of organs available for transplantation. In this article, we review common physiologic alterations seen in organ donors with a focus on brain-dead organ donors. These physiologic alterations and recommended interventions to optimize the physiology of the brain-dead organ donor are discussed by organ system, providing a framework for trauma surgeons and intensivists involved in the care of organ donors.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"162-168"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516026","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 abdomen does not lie, but the labs might: Predictors of intra-abdominal injury on computed tomography imaging in pediatric blunt trauma patients.","authors":"Banan W Otaibi, Muhammad Haris Khurshid, Omar Hejazi, Kati Hage, Collin Stewart, Christina Colosimo, Audrey L Spencer, Michael Ditillo, Louis J Magnotti, Bellal Joseph","doi":"10.1097/TA.0000000000004549","DOIUrl":"10.1097/TA.0000000000004549","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple studies have indicated that isolated abnormal laboratory results necessitate obtaining abdominal computed tomography (CT) for pediatric patients with blunt abdominal trauma (BAT), regardless of the normal abdominal examination. This study aims to identify the predictors of intra-abdominal injury (IAI) and the role of laboratory tests in CT imaging among pediatric BAT patients.</p><p><strong>Methods: </strong>This is a retrospective review at a Level II pediatric trauma center (2018-2022). Children (younger than 18 years) who presented with BAT and received abdominal CT imaging were included. Outcomes were rates of IAI and interventions. Multivariable regression analysis was performed.</p><p><strong>Results: </strong>Over 5 years, 483 patients met the inclusion criteria. The mean age was 13 years, 58.2% were male, and the median Glasgow Coma Scale was 15. Overall, 19.3% had abdominal pain; 6.2%, postinjury emesis; 26.1%, abdominal tenderness; and 10.6%, pelvic tenderness. On initial imaging, 7.0% had a positive focused assessment with sonography in trauma examination, and 7.2% had an abnormal plain x-ray. On initial laboratory testing, 7.9% had abnormal serum aspartate aminotransferase (AST), 3.1% had abnormal hematocrit, 1.2% had abnormal urine analysis, and 0.8% had abnormal lipase. Seventeen percent had at least one IAI, of which 17% underwent intervention. Multivariable regression analysis identified abdominal tenderness, abnormal plain x-ray, positive focused assessment with sonography in trauma, blood transfusion requirements, and abnormal AST as independent predictors of IAI on abdominal CT imaging. Moreover, among patients with IAI, only 37.3% had abnormal laboratory results, and all had at least one of the predictors of IAI (in addition to or other than abnormal AST). Among patients with abnormal laboratory results (n = 57), nine patients had none of the predictors of IAI, out of which none were found to have IAI on abdominal CT.</p><p><strong>Conclusion: </strong>More than 80% of all abdominal CT imaging had negative results. Our findings highlight the significance of clinical findings in the trauma bay, regardless of laboratory findings, when deciding to order abdominal CT imaging for pediatric BAT patients.</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":"181-187"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931448","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 acute mesenteric ischemia: What you need to know.","authors":"Matti Tolonen, Pirkka Vikatmaa","doi":"10.1097/TA.0000000000004585","DOIUrl":"10.1097/TA.0000000000004585","url":null,"abstract":"<p><strong>Abstract: </strong>Acute mesenteric ischemia (AMI) is associated with high mortality rates. There are multiple challenges to establishing an accurate early diagnosis and providing state-of-the-art care for AMI patients. A high index of suspicion is key for early diagnosis. Once suspicion is raised, a triphasic computed tomography angiography is the essential diagnostic tool. Avoiding delays, using hybrid operating rooms and contemporary revascularization techniques for arterial occlusive AMI, can significantly improve the prognosis. Regional health care systems should be developed to direct AMI patients into centers with sufficient capabilities for providing all aspects of care at all hours. The acute care surgeon has a central role in performing laparotomies and bowel resections when needed and coordinating the management flow in close collaboration with vascular surgeons and interventional radiologists for prompt and effective revascularization. A significant share of patients with an arterial occlusive AMI can be managed by endovascular revascularization without the need for a laparotomy. There are no reliable tools for predicting transmural bowel necrosis, and individual assessment and clinical experience are very important in decision-making when choosing between laparotomy and close observation. During laparotomy, an atherosclerotic occlusion at the root of the superior mesenteric artery can be stented by using a retrograde open mesenteric or percutaneous approach, and surgical bypass is seldom needed. Using hospital-specific management pathways is very useful for the standardization of care in arterial occlusive AMI. In venous AMI, systemic anticoagulation is sufficient in most cases. In patients whose symptoms do not resolve, there are various options for endovascular and surgical revascularization. In nonocclusive mesenteric ischemia, prevention by maintaining sufficient abdominal perfusion pressure is key. High-level evidence is scarce, but with current knowledge, the prognosis of AMI patients has plenty of room for improvement.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"151-161"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663717","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":"Investigating the protective effect of direct peritoneal resuscitation on intestinal barrier function in rat models of sepsis.","authors":"Jiamin Ji, Zhirong Zhao, Lan Ming, Zhaofeng Luo, Mingyi Li, Weiliang Tian, Fan Yang, Qian Huang","doi":"10.1097/TA.0000000000004616","DOIUrl":"10.1097/TA.0000000000004616","url":null,"abstract":"<p><strong>Background: </strong>In sepsis, hypercytokinemia increases intestinal permeability, leading to bacterial translocation, which further exacerbates systemic inflammation and multiple organ dysfunction. This study investigates the impact of direct peritoneal resuscitation as an adjunctive treatment on intestinal barrier integrity in rat models of sepsis induced by severe intra-abdominal infection.</p><p><strong>Methods: </strong>A cecal ligation and puncture procedure was performed on Sprague-Dawley rats to establish a sepsis model, with random allocation to the following resuscitation groups (n = 8): Sham, SP (sepsis), CR (conventional intravenous resuscitation), PLS (peritoneal lavage with normal saline), Lac-PDS (peritoneal lavage with 2.5% Glu-Lac-PDS), and Pyr-PDS (peritoneal lavage with 2.5% Glu-Pyr-PDS). The laboratory results, serum inflammatory cytokines, hematoxylin and eosin staining, transmission electron microscopy, intestinal tight junction protein and mucins expression levels, and serum D-lactate levels of rats in each group were observed. p <0.05 was regarded as statistically significant.</p><p><strong>Results: </strong>After direct peritoneal resuscitation treatment, white blood cell and interleukin-10 were significantly increased; lactate, tumor necrosis factor α, and interleukin-6 were significantly decreased; liver and kidney functions were significantly improved; and intestinal pathological damage and subcellular changes were significantly reduced. The expressions of tight junction proteins and mucins were increased, and serum D-lactate was significantly reduced. The efficacy of the Pyr-PDS group was better than other treatment groups.</p><p><strong>Conclusion: </strong>Direct peritoneal resuscitation adjunctive therapy improved overall condition and barrier function of intestine in rat models of sepsis induced by severe intra-abdominal infection. Pyr-PDS demonstrated greater efficacy than Lac-PDS in reducing inflammation and protecting intestinal barrier function.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"264-271"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094132","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":"Nonpharmacological interventions to reduce posttraumatic stress disorder, depression, or anxiety symptoms after trauma: A systematic review and meta-analysis.","authors":"Justin Solarczyk, Matt Ciminero, Sheila Sprague, Heather A Vallier, Saam Morshed","doi":"10.1097/TA.0000000000004673","DOIUrl":"10.1097/TA.0000000000004673","url":null,"abstract":"<p><strong>Background: </strong>Recent novel digital interventions may be transformative in overcoming persistent barriers to access in-person psychological therapies.</p><p><strong>Objective: </strong>This study aimed to synthesize evidence from randomized controlled trials (RCTs) of nonpharmacological interventions that prevents or treats anxiety, depression, or posttraumatic stress disorder (PTSD) among civilians recovering from physical traumatic injury.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, PsychINFO, Cochrane Central Register of Controlled Trials, and Google Scholar for articles since inception to December 28, 2023. We performed English-language RCTs of patients 18 years or older who sustained a physical injury and were assessed for symptoms of PTSD, depression, or anxiety within 1 year of injury. Dual reviewers performed screening for advancement to full-text review, data extraction, and final eligibility for systematic review and meta-analysis, and conflicts were resolved by the senior author. Meta-analysis used random effects. The primary outcome was standardized mean difference (SMD) between intervention and comparator groups.</p><p><strong>Results: </strong>We identified 3,001 articles for title and abstract review. Overall, nonpharmacological interventions significantly prevented or treated PTSD (pooled SMD, -0.71; 95% confidence interval [CI], -1.06 to -0.36), depression (pooled SMD, -0.42; 95% CI, -0.68 to -0.17), and anxiety (pooled SMD, -0.69; 95% CI, -1.01 to -0.37). Cognitive behavioral therapy (CBT) was associated with decreased symptoms of PTSD (pooled SMD, -1.10; 95% CI, -1.54 to -0.66), depression (pooled SMD, -0.87; 95% CI, -1.22 to -0.52), and anxiety. Non-CBT significantly reduced anxiety (pooled SMD, -0.40; 95% CI, -0.74 to -0.07). Collaborative care, non-CBT, and digital treatments failed to reach significance for PTSD and depression.</p><p><strong>Conclusion: </strong>Our systematic review and meta-analysis of RCTs suggest efficacy of CBT for PTSD, depression, and anxiety and non-CBT for anxiety, after physical trauma.</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":"289-297"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172904","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":"Blunt cerebrovascular injury in children: A prospective multicenter ATOMAC+ study.","authors":"Ruth A Lewit, Todd A Nickoles, Regan Williams, David M Notrica, Rachael L Stottlemyre, Mark Ryan, Jeremy J Johnson, Jessica A Naiditch, Karla A Lawson, Robert Todd Maxson, Sandra Grimes, James W Eubanks","doi":"10.1097/TA.0000000000004620","DOIUrl":"10.1097/TA.0000000000004620","url":null,"abstract":"<p><strong>Background: </strong>The incidence of blunt cerebrovascular injury (BCVI) in children remains largely unknown, with only 16.5% of children receiving appropriate screening. This study sought to determine the impact of a screening guideline on injury detection and outcomes in children with BCVI.</p><p><strong>Methods: </strong>This was a prospective, multi-institutional observational study of children younger than 15 years with blunt trauma to the head, face, or neck (Abbreviated Injury Scale score, >0) at any of six level 1 pediatric trauma centers. All patients were screened using the Memphis criteria. Head/neck computed tomography angiogram was recommended for those meeting the criteria. Treatment for BCVI was recommended based on overall trauma burden, with 7- to 10-day follow-up imaging.</p><p><strong>Results: </strong>A total of 2,285 patients met the inclusion criteria. Of those, 520 (23%) (median age, 7.9 years) met the Memphis screening criteria, and 222 (42.5%) received appropriate imaging. A total of 30 BCVIs were identified in 25 patients (1.05%); 22 (88%) had a carotid injury, and 6 (24%) had a vertebral artery injury. Motor vehicle collision was the most common mechanism (42%). Those with BCVIs were older (8.01 years, p = 0.03), with a lower median Glasgow Coma Scale (7.8 vs. 15, p < 0.0001). All but three met the Memphis screening criteria (sensitivity, 88%). Eight (32%) underwent treatment. Six children with BCVI suffered a stroke (24%): two untreated and one treated patient developed a stroke after diagnosis.</p><p><strong>Conclusion: </strong>Similar to adults, BCVI in children screened has an incidence of 1% (overall incidence of 0.33% in all blunt trauma) and carries a significant risk of stroke. Treatment of BCVI in children in this study is inconsistently applied even after diagnosis, and stroke may still occur with treatment.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"245-252"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989503","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}