Journal of Trauma and Acute Care Surgery最新文献

{"title":"Prolonged tourniquet use in extremity trauma: What you need to know.","authors":"Daniel Lammers, Reynold Henry, John McClellan, Scott Armen, Eric Koch, Eric Sulava, Tom Lefebvre, Matthew Eckert, Kenji Inaba, John B Holcomb","doi":"10.1097/TA.0000000000005108","DOIUrl":"10.1097/TA.0000000000005108","url":null,"abstract":"<p><strong>Abstract: </strong>Routine tourniquet use has significantly improved early survival in both military and civilian settings for extremity hemorrhage in trauma patients. However, most supporting evidence revolves around short-duration tourniquet use stemming from trauma systems with rapid evacuation and early surgical care. Emerging military operations and austere civilian settings risk prolonged prehospital times, introducing uncertainty in the management of prolonged tourniquet application. These scenarios present high-risk situations for medical providers and potentially life-threatening complications for patients. Despite this, management strategies during these scenarios remain poorly defined. This review synthesizes current military and civilian literature to address key challenges in prolonged ischemia, including tourniquet conversion, decision-making surrounding limb salvage versus early amputation, and the pathophysiology and management of ischemia reperfusion injury.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"711-722"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272014","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":"Meeting Courses.","authors":"","doi":"10.1097/01.ta.0001279692.67118.14","DOIUrl":"https://doi.org/10.1097/01.ta.0001279692.67118.14","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":"101 5","pages":"913"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245242","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":"Platelet storage lesion underlies changes in plasminogen activator inhibitor-1 activity in stored whole blood.","authors":"Elizabeth R Maginot, Nicolle K Barmettler, Flobater I Gawargi, Ernest E Moore, Collin M White, Dylan C Hiser, Ashley A Clegg, Kyle S Sextro, Trace B Moody, Grace E Volk, Hunter B Moore, Natasha Goodman, Aleh Bobr, Reynold Henry, Christopher D Barrett","doi":"10.1097/TA.0000000000005012","DOIUrl":"10.1097/TA.0000000000005012","url":null,"abstract":"<p><strong>Background: </strong>Whole blood transfusion is increasingly used in trauma resuscitation. However, stored whole blood units demonstrate increasing susceptibility to tissue plasminogen activator-mediated fibrinolysis despite paradoxical increases seen in plasminogen activator inhibitor-1 (PAI-1) activity over time. Whether early variability in PAI-1activity exists across whole blood units and the biologic contributors to this variability remain unclear. Two distinct donor pools were identified: one with high PAI-1 activity and one with low PAI-1 activity. We set out to determine whether PAI-1 activity in whole blood donors primarily comes from the endothelium or from platelet degranulation.</p><p><strong>Methods: </strong>Plasma from whole blood units (n = 28) was generated via serial centrifugation at two time points during storage (Days 1-3 and Day 21). Activity assays were performed for PAI-1 using a modified enzyme-linked immunosorbent assays that only captures active PAI-1. Soluble CD40 ligand (sCD40L), a platelet-derived marker of activation, degranulation and death, and total von Willebrand Factor antigen levels, which are highly specific for endothelial degranulation, were quantified using enzyme-linked immunosorbent assays. Statistical analysis was performed via two-tailed t-tests. Significance was set at p <0.05.</p><p><strong>Results: </strong>Whole blood units stratified into distinct high and low PAI-1 activity cohorts at early storage time points. Over storage, PAI-1 activity increased overall. sCD40L levels increased approximately 4-fold during storage, consistent with a platelet storage lesion. At early time points, both sCD40L and von Willebrand Factor antigen levels were significantly higher in the high PAI-1 cohort, suggesting contributions from both platelet-derived and donor endothelial factors.</p><p><strong>Conclusion: </strong>Stored whole blood demonstrates early, donor-dependent heterogeneity in antifibrinolytic potential, reflected by distinct PAI-1 activity cohorts at time of donation. This appears to have a mixed source, with evidence for both endothelial and platelet factors that may differ from donor to donor.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"769-776"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775317","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 long road home: A WTA multicenter study of patient preferences and risk tolerance in the regionalization of acute care surgery.","authors":"Corey Ambrose, Patrick McGillen, Steven Forman, Andrew Maneval, Sophie Gonzalez, Aricia Shen, Galinos Barmparas, Avital Zucker, Mallory Jebbia, Jeffry Nahmias, Marila Montenegro, Seba Abdullah, Xian Luo-Owen, Martin Rosenthal, Alexis Moren, Eddie Rodriguez, Shea Gallagher, Anaar Siletz, Kazuhide Matsushima, Kenji Inaba, Matthew J Martin","doi":"10.1097/TA.0000000000005049","DOIUrl":"10.1097/TA.0000000000005049","url":null,"abstract":"<p><strong>Background: </strong>Regionalization of acute care surgery (ACS) aims to improve outcomes by transferring complex cases from local hospitals to tertiary centers. Although improved outcomes have been demonstrated for select conditions, regionalization may impose social and financial burdens, and patient preferences in the ACS setting remain poorly characterized. We evaluated patient preferences and risk tolerance related to ACS regionalization in a multicenter cohort.</p><p><strong>Methods: </strong>We prospectively surveyed 602 adults with trauma or emergency general surgery (EGS) conditions at five trauma centers. Using a modified standard gamble utility assessment, patients indicated preferences for local care versus regional transfer under scenarios of equal perioperative risk and increasing hypothetical risks at their local hospital (absolute increases of 2%, 4%, 6%). Demographics and clinical variables were collected. Univariate analyses identified factors associated with local versus regional preference, and multivariable logistic regression determined independent predictors of site preference.</p><p><strong>Results: </strong>Among 602 patients [67% EGS, 33% trauma, median age 50 (interquartile range: 24-61); 60% males], most preferred local care when complication or mortality risks were equivalent between hospitals (93% and 92%, respectively). As local risk increased, preference for local care declined; however, nearly half of patients preferred to remain at their local hospital despite a doubling of complication or mortality risk (4% vs. 2%). Preference for regional transfer at this inflection point was associated with higher household income, younger age, willingness to travel for specialty care, intensive care unit admission, and prior transfer. Trauma versus EGS diagnosis and mechanism did not predict site preference. Substantial variation in risk tolerance was observed across centers.</p><p><strong>Conclusions: </strong>ACS patients strongly prefer local care when outcomes are equivalent, and many are willing to forego interhospital transfer despite substantially increased risk. These findings highlight a discordance between patient preferences, risk tolerance, and regionalization practices, underscoring the need to incorporate patient perspectives into ACS transfer decision-making. ( J Trauma Acute Care Surg. 2026;101: 894-902.).</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":"894-902"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868780","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 intravenous targeted nanopeptide, CAQK, is neuroprotective and improves motor function after spinal cord injury in rats.","authors":"Jose A Castillo, Jay Uppuluri, Michael Le, Taylor Tran, Christopher Pivetti, Kuan-Wei Huang, Sina Vatoofy, Amanda Ratcliff, Andrei Dangan, Solomon Bannerman, Maya Lee, Mehrad Shahin, Emma Loll, Kaitlin Clark, Aijun Wang, Rachel Russo","doi":"10.1097/TA.0000000000005054","DOIUrl":"10.1097/TA.0000000000005054","url":null,"abstract":"<p><strong>Background: </strong>CAQK is a homing peptide that targets sites of central nervous system injury and has previously demonstrated functional benefits in traumatic brain injury models. We recently demonstrated its localization to spinal cord injury (SCI) after intravenous administration and hypothesized that it could enhance motor recovery after SCI.</p><p><strong>Methods: </strong>Twelve female Sprague-Dawley rats underwent C5 right-sided spinal cord hemicontusion. Animals were randomized to receive intravenous CAQK (2.5 mg/kg) or saline daily for 7 days, beginning 1 hour postinjury. Motor performance was assessed using the Irvine, Beatties, and Bresnahan (IBB) Forelimb Recovery Scale, a scale from 0 to 9, with 9 being normal function. IBB score was assessed at five time points over 8 weeks, followed by histological analysis. An in vitro neuroprotection assay was also conducted to evaluate the neuroprotective effects of CAQK at various doses.</p><p><strong>Results: </strong>All animals exhibited motor deficits immediately after injury. Compared with saline controls, CAQK-treated rats demonstrated significantly improved motor recovery at 1, 2, 5, and 8 weeks postinjury (week 8: IBB = 7 vs. 3; p = 0.01). Histologic analysis showed significantly reduced astroglial activation in the CAQK group (GFAP: treated = 0.1±0.01 vs. untreated = 0.7±0.2; p = 0.002) and increased axonal preservation (NFM: treated = 0.3±0.06 vs. untreated = 0.1±0.06; p = 0.03). In vitro, CAQK significantly enhanced neuronal network complexity compared with saline ( p < 0.05).</p><p><strong>Conclusions: </strong>CAQK treatment significantly improved motor outcomes compared with saline-only treatment. Ex vivo analysis of spinal cord tissue showed enhanced tissue recovery in CAQK-treated rats. In vitro, neuroprotection was evident in cells treated with CAQK. Overall, these findings support CAQK's potential as a targeted therapeutic candidate for SCI.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"827-834"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361356","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":"Socioeconomic and geographic variation in response to trauma medical home intervention.","authors":"Saba Ilkhani, Malaz Boustani, Emma Holler, Damaris Ortiz, Anthony Perkins, Sujuan Gao, Babar Khan, Ben L Zarzaur","doi":"10.1097/TA.0000000000005150","DOIUrl":"10.1097/TA.0000000000005150","url":null,"abstract":"<p><strong>Background: </strong>Many injury survivors experience persistent biopsychosocial morbidity after hospital discharge. The trauma medical home (TMH), a multidisciplinary coordinated care model, demonstrated modest benefit in a multicenter randomized trial, but its effectiveness across rural and socioeconomically deprived populations remains unclear.</p><p><strong>Methods: </strong>This post hoc retrospective analysis of the TMH parent randomized trial included patients aged older than or equal to 50 years with an Injury Severity Score ≥9 across four level I trauma centers. For this study, patients were categorized by rurality and Area Deprivation Index (ADI). Outcomes included the SF-36 Physical and Mental Component Scores (PCS, MCS), depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety [Generalized Anxiety Disorder (GAD-7)], physical function [Short Physical Performance Battery (SPPB)], and health care utilization. Interaction effects between TMH and rural/urban status or ADI were evaluated at baseline, 6 months, and 12 months.</p><p><strong>Results: </strong>Four hundred thirty patients were included [216 TMH and 214 in usual care (UC)]. On the basis of urbanicity, the effectiveness of TMH on quality of life, psychological, physical, and health care utilization was similar at 6 and 12 months. ADI stratification showed greater differences. In high-ADI urban areas, baseline MCS scores were similar between TMH (47.5 ± 13.0) and UC (48.6 ± 12.8). By 6 months, TMH patients improved to 54.9 ± 8.8 compared with 49.0 ± 13.1 in UC, with a predicted difference of 7.7 (95% CI: 1.32, 12.83, P =0.016), demonstrating a clinically and statistically significant benefit of TMH.</p><p><strong>Conclusions: </strong>The TMH was associated with greater mental health improvement among patients with high area deprivation, particularly in urban settings, suggesting a potential role in reducing disparities through coordinated 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":"903-912"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620706","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 provision of palliative care: A Western Trauma Association critical decisions algorithm.","authors":"Jennifer L Hartwell, Craig Follette, Marshall Beckman, Katie Bower, Raul Coimbra, Chasen Croft, Allyson M Hynes, Kenji Inaba, Natasha Keric, Andrew J Kerwin, Tammy Kopelman, Manuel Lorenzo, Gregory A Magee, Alicia Privette, Kevin Schuster, Morgan Schellenberg, Ron Tesoriero, Elizabeth Windell, Deborah Stein","doi":"10.1097/TA.0000000000005112","DOIUrl":"10.1097/TA.0000000000005112","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"751-757"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422032","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":"Buprenorphine analgesia: Impacts on opioid burden and clinical trajectory in acute trauma care.","authors":"Sabri Conde-Yassin, Jacob Gillen, Josh Stodghill, Michael Collins, Katie Bower, Emily Faulks, Bryan Collier","doi":"10.1097/TA.0000000000005084","DOIUrl":"10.1097/TA.0000000000005084","url":null,"abstract":"<p><strong>Background: </strong>Schedule II opioids are widely used for trauma analgesia but carry dose-dependent risks of respiratory depression, tolerance, hyperalgesia, and addiction. Buprenorphine, a Schedule III opioid, is a potent analgesic with a more favorable safety profile; however, its integration into trauma care remains uncharacterized.</p><p><strong>Methods: </strong>A single-center observational study included adult trauma patients admitted to a Level I trauma center from January 2021 to June 2024. The trauma service formalized buprenorphine analgesia in June 2023. Outcomes were assessed by (1) an unadjusted pre/post June 2023 analysis (pre-BΔ vs. post-BΔ) and (2) a 1:1 nearest-neighbor propensity score-matched comparison of post-BΔ patients who received (Bup + ) or did not receive (Bup - ) buprenorphine. Bup + and Bup - groups were matched by demographics and injury characteristics. Sublingual/buccal and parenteral buprenorphine were assigned morphine milligram equivalents (MME) conversion factors of 30 and 100, respectively. Incidence rate ratios (IRRs) with 95% CI were calculated; significance was set at p <0.05.</p><p><strong>Results: </strong>Unadjusted analysis included 3,935 patients (2,777 pre-BΔ; 1,158 post-BΔ). Increased buprenorphine use was associated with reduced MME (median, 138 pre-BΔ vs. 75 post-BΔ; p < 0.001; IRR, 0.70; 95% CI, 0.69-0.71), lower intensive care unit (ICU) admission rates (IRR, 0.78; 95% CI, 0.73-0.83), and shortened ICU length of stay (IRR, 0.87; 95% CI, 0.80-0.94). In the matched post-BΔ cohort (n = 544) buprenorphine use was associated with lower ICU admission (IRR, 0.63; 95% CI, 0.54-0.73) and shorter ICU length of stay (IRR, 0.67; 95% CI, 0.59-0.75); median MME did not differ (114 vs. 91, p = 0.187), though IRR analyses demonstrated lower opioid exposure (IRR, 0.82; 95% CI, 0.81-0.83). Across analyses, no differences were observed in survival or adverse events.</p><p><strong>Conclusions: </strong>In trauma patients, Schedule III buprenorphine analgesia was associated with reduced inpatient opioid exposure and ICU escalation. Further validation may establish buprenorphine as an advance in opioid stewardship for vulnerable trauma populations.</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":"835-843"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226444","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":"Characteristics and time course of postconcussive symptoms in children and adolescents with moderate to severe extracranial trauma with and without mild traumatic brain injury.","authors":"Susan E Biffl, Walter L Biffl, Romeo C Ignacio, Matthew R Castelo, Anna Burch, Adam Gorra, Brandon Schoonover, Paul Cohen, Nancy Rivera, Todd Hightower, Terri-Ann Wattsman, Whitney Wilkes, Nicole Fox, Adam Goldsmith, Johanna Askegard","doi":"10.1097/TA.0000000000005104","DOIUrl":"10.1097/TA.0000000000005104","url":null,"abstract":"<p><strong>Background: </strong>Mild traumatic brain injury (mTBI), including concussion, is common and has received a great deal of attention, but terminology and diagnosis can be confusing. Postconcussive symptoms (PCS) are well-described in the setting of concussion and isolated mTBI, but the individual symptoms are nonspecific and may be present in patients with extracranial injuries without TBI. The time course of PCS has not been well-characterized in patients with extracranial trauma, either with or without concomitant mTBI. We hypothesized that patients with mTBI with moderate/severe extracranial trauma would experience a unique, more severe and longer-lasting pattern of PCS with more negative impact on quality of life (QOL) when compared with similar trauma patients without mTBI.</p><p><strong>Methods: </strong>Prospective multicenter study (2018-2024) of patients aged 5 to 17 with extracranial Injury Severity Score >8, excluding moderate/severe TBI. Patients with and without mTBI (GCS 13-15, alteration of mental status or other signs/symptoms of TBI) were included. Patients were assessed at 1 week, 3 weeks, and 3 months with the Rivermead PCS Inventory and PedsQL QOL assessments.</p><p><strong>Results: </strong>One hundred thirty-four patients were included: 53 (40%) had mTBI. Adolescent mTBI patients had significantly higher PCS Inventory scores than non-mTBI adolescents at T1 and T2. Symptoms persisted in >25% of both groups at T3. The QOL was impacted by the PCS burden.</p><p><strong>Conclusions: </strong>Although attrition compromised the statistical power of the study, many patients with moderate/severe extracranial trauma have a significant PCS burden at 3 months postinjury. Those with mTBI have a greater symptom burden and unique symptomatology compared with those without mTBI. Attention to diagnosis and treatment of mTBI and support and anticipatory guidance for all pediatric moderate/severe trauma patients is warranted.</p><p><strong>Level of evidence: </strong>Prognostic/Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"858-867"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352365","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":"Early cystography after traumatic bladder repair is associated with shorter catheter duration and fewer CAUTIs without increased detection of postoperative leaks.","authors":"Tyler L Holliday, James E Wiseman, Christian D Cain, Bethany L Strong, Shailvi Gupta, Meaghan E Broderick, Thomas M Scalea, Eric J Ley","doi":"10.1097/TA.0000000000005042","DOIUrl":"10.1097/TA.0000000000005042","url":null,"abstract":"<p><strong>Background: </strong>Optimal postoperative management after traumatic bladder repair, such as imaging strategies and catheter duration, remains unclear and may affect the rate of catheter-associated urinary tract infections (CAUTIs). We evaluated early (≤7 d) versus late (≥8 d) or no postoperative cystography for traumatic bladder repairs, hypothesizing that early imaging would reduce catheter duration and CAUTI rates without increasing the rate of urinary leak detection.</p><p><strong>Methods: </strong>We retrospectively reviewed trauma registry data from a university-based Level I and II trauma system from 2017 to 2024. Patients with full-thickness bladder injuries undergoing cystorrhaphy were included. Those with in-hospital mortality or concomitant ureteral and/or urethral injuries were excluded. Patients were stratified by timing of initial postoperative cystography: early versus late and early versus none. Primary outcomes included catheter duration, CAUTI rate, and urinary leak rate on initial postoperative imaging.</p><p><strong>Results: </strong>One hundred eighteen patients met the inclusion criteria: 62 (52.5%) isolated intraperitoneal, 39 (33.1%) isolated extraperitoneal, and 17 (14.4%) combined injuries. Eighty-six (71.9%) sustained blunt trauma. Twenty-nine (24.6%) patients underwent early, 70 (59.3%) late, and 19 (16.1%) no postoperative imaging. There were more AAST grade 4 bladder injuries (79.3% vs. 45.7%, p <0.01) in the early versus late cystography cohort. Otherwise, there were no differences in patient demographics, mechanism, injury severity, associated injuries or interventions, or management strategies. Early postoperative imaging was associated with reduced catheter duration (7 [6-10] vs. 14 [11-18] d, p <0.01) and CAUTI rates (6.9% vs. 30%, p =0.02) compared with late imaging. Rates of urinary leak (3.5% vs. 8.6%, p =0.67) were similar. Early postoperative cystography was associated with reduced catheter duration (7 [6-10] vs. 10 [9-15] d, p <0.01) compared with no cystography.</p><p><strong>Conclusions: </strong>Despite having more high-grade injuries, early postoperative cystography was associated with reduced catheter duration and CAUTI rates without an increased urinary leak rate. Early imaging facilitates earlier catheter removal and improves outcomes. ( J Trauma Acute Care Surg . 2026;101: 810-818.).</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":"810-818"},"PeriodicalIF":3.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}