Journal of Trauma and Acute Care Surgery最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","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":"Pushing advanced hemorrhage control interventions forward: Reducing prehospital mortality from traumatic hemorrhage through further adoption of effective military prehospital strategies.","authors":"Daniel Lammers, Reynold Henry, Richard Betzold, Joshua Dilday, John McClellan, Matthew Eckert, John B Holcomb","doi":"10.1097/TA.0000000000004674","DOIUrl":"https://doi.org/10.1097/TA.0000000000004674","url":null,"abstract":"<p><strong>Abstract: </strong>Advancements in military medicine have had profound impacts on civilian trauma care. The current practices in civilian prehospital care focus on providing limited interventions in the field and rapid transport to higher levels of care. Very few prehospital emergency medical services in the United States have the capability to provide prehospital blood transfusions or advanced hemorrhage control procedures for trauma patients in hemorrhagic shock. As such, prehospital mortality from hemorrhage remains high. The United States military has adopted the use of prehospital blood transfusions during recent combat operations in the Middle East to mitigate prehospital mortality. Additionally, select military surgical teams capable of providing damage-control surgery as close to the point of injury as possible have been used to decrease the time to lifesaving interventions. This review seeks to assess current practices in civilian prehospital care within the United States while evaluating recent military medical lessons learned on prehospital blood products and minimizing time to lifesaving interventions, to identify potential opportunities to reduce mortality in civilian prehospital trauma care.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level V.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258356","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":"Association between coagulation biomarkers, intracranial hemorrhage types, and tranexamic acid treatments in early traumatic brain injury.","authors":"Karen G Minoza, Alexandra Mp Brito, Lindsey Loss, Scott McLoud, James El Haddi Kenny, William J McLean, Linda Papa, Susan Rowell, Martin Schreiber","doi":"10.1097/TA.0000000000004669","DOIUrl":"https://doi.org/10.1097/TA.0000000000004669","url":null,"abstract":"<p><strong>Background: </strong>Although a prehospital 2 g bolus of tranexamic acid (TXA) has been associated with decreased mortality in patients with traumatic intracranial hemorrhage (ICH), the underlying mechanism remains controversial. We investigated whether early coagulation biomarkers are associated with ICH type, prehospital TXA treatment, and outcomes in patients with early traumatic brain injury (TBI).</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Prehospital TXA for TBI trial (Glasgow Coma Scale score of <13 and systolic blood pressure of ≥90 mm Hg in patients blindly randomized prehospital to either a 2 g TXA bolus, 1 g TXA bolus plus 1 g TXA infusion, or placebo bolus plus infusion). Intracranial hemorrhage types were categorized as extradural, subdural, subarachnoid, intraventricular, intraparenchymal, mixed, any ICH, and no ICH. Outcomes including Glasgow Outcome Score-Extended, Disability Rating Score, and mortality were examined at discharge and 6 months. Associations between biomarkers, ICH type, TXA treatment group, and outcomes were examined.</p><p><strong>Results: </strong>Of 783 patients, 464 had ICH (5 extradural, 40 subdural, 84 subarachnoid, 7 intraventricular, 26 intraparenchymal, 302 mixed, 464 any ICH), and 319 had no ICH. Three markers of fibrinolytic activity (D-dimer, plasmin-α2-antiplasmin complex [PAP], and thrombin-antithrombin complex [TAT]) were significantly increased in the presence of any ICH and mixed ICH. Higher D-dimer, PAP, and TAT levels were associated with increased mortality, and worse Glasgow Outcome Score-Extended and Disability Rating Score at discharge and 6 months. Plasmin-α2-antiplasmin complex was associated with TXA treatment, with lower PAP levels associated with the higher initial TXA bolus dose.</p><p><strong>Conclusion: </strong>In patients with early TBI, D-dimer, PAP, and TAT are associated with the presence of any ICH and mixed ICH. Higher D-dimer, PAP, and TAT levels are associated with neurologic outcomes. Only PAP is associated with TXA treatment. Future studies should examine the utility of PAP as a potential marker for TXA responsiveness.</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":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258344","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":"Hospital-based violence intervention programs may positively influence mental health outcomes.","authors":"Nathaniel Pinkes, Molly P Jarman, Saba Ilkhani, Farzad Noubary, George Velmahos, Ali Salim, Juan P Herrera-Escobar, Geoffrey A Anderson","doi":"10.1097/TA.0000000000004702","DOIUrl":"https://doi.org/10.1097/TA.0000000000004702","url":null,"abstract":"<p><strong>Background: </strong>Hospital-based violence intervention programs (HVIPs) are interdisciplinary teams and interventions designed to improve outcomes for violently injured patients. There is a lack of literature showing longitudinal assessment of mental health outcomes among survivors of violence who use HVIPs. This study examines whether HVIP engagement by survivors of community violence improves long-term mental health-related quality of life. We hypothesize that victims of violence who engaged with HVIP programming will show better mental health-related quality of life scores 6 to 12 months following their injury.</p><p><strong>Methods: </strong>In this prospective nested cohort study, adult survivors of community violence with moderate to severe injuries (Injury Severity Score, ≥9) admitted to two level I trauma centers between December 2015 and July 2020 were interviewed 6 to 12 months after injury. Short Form-12 mental and physical health component score data were collected. Multivariable linear regression was used to estimate the adjusted mean difference in component scores given HVIP engagement.</p><p><strong>Results: </strong>Of 98 patients with a violent injury, 17 (17.3%) had true HVIP use. Using an as-treated approach, patients who engage with an HVIP have a greater mean mental health component score compared with patients who do not engage with an HVIP (54 [95% confidence interval, 49-75] vs. 41 [95% confidence interval, 32-52]; p = 0.002). There is no significant difference in physical health component score, all-cause, and trauma-related readmission between patients who do and do not engage with an HVIP following violent injury.</p><p><strong>Conclusion: </strong>This study demonstrates that HVIPs may be associated better long-term mental health outcomes among patients who suffer violent injuries. These findings should encourage further implementation, funding, and evaluation of HVIPs that may help mitigate the sequelae of violent injury.</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":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258354","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":"Morbidity and mortality associated with ischemia-reperfusion injury after prolonged tourniquet use: A wartime single-center treatment algorithm.","authors":"Vitalii Lukiianchuk, Oleksandr Linchevskyy, Warren C Dorlac, Rachel M Russo, Pamela B Andreatta, Shahram Aarabi, Sahil Patel, Frank K Butler, Travis M Polk, John B Holcomb","doi":"10.1097/TA.0000000000004677","DOIUrl":"https://doi.org/10.1097/TA.0000000000004677","url":null,"abstract":"<p><strong>Background: </strong>The evolving warfare tactics used by near-peer adversaries are expected to increase the incidence of severe extremity injuries and delayed evacuations. Initial reports from combat in Ukraine suggest high complication rates associated with prolonged tourniquet use. This study aimed to evaluate the systemic effects of limb reperfusion following tourniquet application lasting 4 hours or more in patients with isolated extremity injuries. Patients were treated according to an evidence-based protocol designed to mitigate ischemia-reperfusion injuries.</p><p><strong>Methods: </strong>This retrospective review was conducted at a forward surgical facility in Ukraine during combat operations from May 2023 to February 2024. Patients with tourniquets in place for at least 4 hours were included, while those with contraindications to limb salvage or significant confounding injuries were excluded. Short-term outcomes assessed included limb salvage, organ failure, and survival rates.</p><p><strong>Results: </strong>Of the 1,945 casualties screened, 90 (4.6%) met the inclusion criteria. After excluding 16 patients, outcomes were analyzed for 74 males, with an average age of 41.6 ± 8.5 years and a mean tourniquet duration of 7.1 ± 2.9 hours. Among these, 19 patients (25.67%) had vascular injuries, and compartment syndrome was present in all cases. Hemodialysis was required for 58 patients (70.8%), while 27 (36.3%) needed a delayed limb amputation, and 5 patients (6.7%) died. Patients requiring dialysis underwent an average of 3 ± 2 sessions to recover kidney function. Longer tourniquet times increased the need for dialysis, which increased the likelihood of patient death.</p><p><strong>Conclusion: </strong>We used a standardized ischemia-reperfusion algorithm to reduce the systemic effects of ischemia and reperfusion during attempts to salvage limbs following 4 hours or more of tourniquet time. Preliminary outcomes indicate that survival is probable, kidney function may improve with brief periods of dialysis, and limb salvage is possible in most cases.</p><p><strong>Level of evidence: </strong>Retrospective Cohort Study; Level V.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258355","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 Joint Trauma System: A critical lifeline facing an uncertain future.","authors":"Reynold Henry, Jennifer Gurney, Scott Armen, Christopher D Barrett, Brian Gavitt, Philbert Van, Daniel Lammers, John McClellan, Martin Schreiber","doi":"10.1097/TA.0000000000004688","DOIUrl":"https://doi.org/10.1097/TA.0000000000004688","url":null,"abstract":"<p><strong>Abstract: </strong>The Joint Trauma System (JTS) has become a cornerstone of modern trauma care, revolutionizing battlefield treatment and saving countless lives through standardized, evidence-based protocols. Its development and success are rooted in lessons learned from the wars in Iraq and Afghanistan, where fragmented systems were transformed into cohesive, high-performing networks. The JTS has influenced not only military but also civilian trauma care, fostering a symbiotic relationship that advances innovation across both sectors. Despite its proven effectiveness, a growing movement within the US military questions its relevance during peacetime, threatening its existence. This article examines the history, impact, and future of the JTS while emphasizing the critical need for civilian advocacy to preserve its role as a key enabler of military readiness and trauma care innovation.</p><p><strong>Level of evidence: </strong>Expert Opinion; Level V.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258359","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":"Source control in intra-abdominal infections: What you need to know.","authors":"Federico Coccolini, Andrew W Kirkpatrick, Camilla Cremonini, Massimo Sartelli","doi":"10.1097/TA.0000000000004654","DOIUrl":"https://doi.org/10.1097/TA.0000000000004654","url":null,"abstract":"<p><strong>Abstract: </strong>Providing optimal source control (SC) for intra-abdominal sepsis (IAS) is a critically important surgical principle, yet one that remains nebulous in terms of strict definitions and required conduct. The entire concept of SC has evolved in the last decades. Contemporary SC is not only surgical but also embraces minimally invasive percutaneous and medical therapies. We propose that adequate SC has evolved from the mere anatomical control of enteric leakage, cleansing of obvious contaminants and necrosis, to a more comprehensive anatomo-phyiological-biochemical model. While any breaches in the integrity of the gastrointestinal tract should be addressed urgently, SC should ultimately aim to control the generation and propagation of systemic biomediators, bacterial toxins, and toxic catabolites that perpetuate multisystem organ failure and death. Much urgently needs to be learned to understand and hopefully mitigate the dysbiotic influences of IAS on the human microbiome. Finally, the therapy offered should always be individualized, recognizing patient's unique pathophysiology, clinical condition, comorbidities, and predeclared preferences regarding invasive therapies and life-support.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258358","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":"Computed tomography after an abdominal gunshot wound: Be careful not to be navel-gazing.","authors":"Évelyne Peroux, Yvain Goudard, Nicolas Cazes","doi":"10.1097/TA.0000000000004576","DOIUrl":"https://doi.org/10.1097/TA.0000000000004576","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258346","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":"An analysis of potential cervical spine clearance in children with computed tomography alone.","authors":"Katie W Russell, Anastasia M Kahan, R Scott Eldredge, Robert A Swendiman, Zachary J Kastenberg, Annika B Kay, John W Rampton, Kelly Huynh, Hsuan-Yu Wan, David S Morris, Rajiv R Iyer, Vijay M Ravindra, Douglas L Brockmeyer","doi":"10.1097/TA.0000000000004667","DOIUrl":"https://doi.org/10.1097/TA.0000000000004667","url":null,"abstract":"<p><strong>Introduction: </strong>Clearance of the pediatric cervical spine (CS) after trauma remains a challenge. While missing an injury is unacceptable, prolonged immobilization is also detrimental. We aimed to determine the sensitivity and negative predictive value of computed tomography (CT) for the identification of clinically significant cervical spine injuries (CSIs) in pediatric blunt trauma patients across a large health system. We hypothesized that CT would be highly sensitive for detecting CSIs across a diverse network of hospitals.</p><p><strong>Methods: </strong>A retrospective cohort study of pediatric patients younger than 18 years with trauma diagnosis codes who underwent CS imaging within 24 hours of presentation to an emergency department was conducted across a mixed adult and pediatric 23-hospital system from January 2012 through December 2023. A clinically significant CSI was defined as an injury requiring CS surgery or halo placement within 7 days of presentation. Patients who underwent CT and had a clinically significant CSI were compared with those without.</p><p><strong>Results: </strong>A total of 14,232 pediatric trauma patients were evaluated with CS CTs. An additional 10,900 with minor trauma were screened with x-ray and no CT. Of patients who underwent CT, 109 (0.8%) had CSIs. On univariate analysis, CSI patients were more likely to be obtunded shown by an increase in intubation (19% vs. 5%, p < 0.001), and a Glasgow Coma Scale score of <14 (22% vs. 6%, p = 0.049). Four patients with CSIs had normal CTs per initial radiographic report. Post hoc analysis by an expert spine panel identified abnormalities on all CTs. The sensitivity of CT for diagnosing CSI was 96%, and the negative predictive value was 100%. This was consistent across all age groups.</p><p><strong>Conclusion: </strong>Computed tomography has a high sensitivity for detecting clinically significant CSIs in pediatric trauma patients across all ages and a wide variety of hospitals. Consideration must be given to clearing the pediatric CS based on a negative CT in the absence of symptoms.</p><p><strong>Level of evidence: </strong>Retrospective Cohort Study; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258343","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":"Does pediatric trauma center designation matter for children in shock from gunshot wounds? A Trauma Quality Improvement Program analysis.","authors":"Micaela K Gomez, Elizabeth C Wood, Maximilian Peter Forssten, Timothy K Williams, Sebastian Peter Forssten, Babak Sarani, Shahin Mohseni, Lucas P Neff","doi":"10.1097/TA.0000000000004637","DOIUrl":"https://doi.org/10.1097/TA.0000000000004637","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have demonstrated improved outcomes for severely injured pediatric trauma patients treated at pediatric trauma centers (PTCs). Nonetheless, specific injury patterns requiring immediate lifesaving intervention may offset the recognized benefits of PTC over adult trauma centers (ATCs). This study aims to compare the clinical outcomes of hypotensive pediatric trauma patients with gunshot wounds (GSWs), based on trauma center type. We hypothesize that outcomes are equivalent for this clinical scenario.</p><p><strong>Methods: </strong>The 2013-2021 Trauma Quality Improvement Program data set was used to identify all hypotensive pediatric patients (15 years or younger) with GSWs. Hypotension was defined per Pediatric Advanced Life Support Guidelines. Patients with an Abbreviated Injury Scale score of 6 in any region and transferred patients were excluded. In order to identify the association between PTC verification status and outcomes, Poisson regression models with robust standard errors were used.</p><p><strong>Results: </strong>A total of 687 patients met the criteria for analysis, and 236 (34%) cases were treated at PTCs. Pediatric trauma center patients were slightly younger (lower quartile, 10 vs. 12 years old; p = 0.037). There was no significant difference in Injury Severity Score or crude mortality rates (68.1% vs. 70.8%, p = 0.524). After adjusting for confounders, Poisson regression showed no reduction in in-hospital mortality, complications, failure to rescue, intensive care unit admission, or mechanical ventilation rates at PTCs compared with ATCs.</p><p><strong>Conclusion: </strong>Gunshot wounds in children pose unique clinical challenges. Majority of cases are cared for at ATCs. Analysis of best available data did not demonstrate a benefit to managing these patients at a PTC. Conversely, ATCs were not superior, despite managing this scenario in both adults and children more often. These findings underscore the importance of ATCs in the care of this particular injury pattern and call attention to the recent pediatric readiness requirements for American College of Surgeons (ACS)-verified trauma centers to treat pediatric firearm injuries at both PTCs and ATC.</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":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258347","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}