Trauma Surgery & Acute Care Open最新文献

{"title":"Guidelines for essential trauma care: from recommendation to implementation across all countries of varied income levels.","authors":"Timothy C Hardcastle, Charles Mock, Christine Gaarder","doi":"10.1136/tsaco-2026-002444","DOIUrl":"10.1136/tsaco-2026-002444","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002444"},"PeriodicalIF":2.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding access to prehospital blood products: a narrative review of clinical evidence, systems barriers, and statewide strategies.","authors":"Jamison P Geracci, Spencer M Knierim, Alexander F Bowers, Hannah L Borland, Evan Baines, Cory Lacek, Peter Antevy, Jennifer A Shuford, Kenneth A Scheppke, Traceee Rose, Eric Epley, John B Holcomb, Randall Schaefer, Donald H Jenkins","doi":"10.1136/tsaco-2026-002321","DOIUrl":"10.1136/tsaco-2026-002321","url":null,"abstract":"<p><p>Traumatic hemorrhage remains a leading cause of preventable death in the USA, and early administration of blood products improves outcomes in hemorrhagic shock. However, access to prehospital transfusion on ground ambulances remains limited and uneven. This narrative review synthesizes current clinical evidence, implementation barriers, and emerging models for prehospital blood use in the USA, with a focus on the potential role of statewide coordination within trauma systems. A targeted review of peer-reviewed literature, consensus guidelines, and system implementation reports was conducted, examining clinical efficacy, trauma system integration, regulatory frameworks, logistical considerations, reimbursement challenges, and statewide strategies. Approximately 3% of the 11 450 eligible US 9-1-1 ground emergency medical service (EMS) units currently provide prehospital blood transfusion, with access largely determined by local resources rather than patient need. Major barriers include logistical and stewardship challenges, lack of sustainable reimbursement pathways, absence of centralized data infrastructure, and the decentralized nature of the US blood supply. Clinical evidence supports the use of blood products for both traumatic and non-traumatic hemorrhage, demonstrating improvements in early hemodynamics and survival. Emerging efforts, including those led by the Prehospital Blood Transfusion Coalition and coordinated initiatives in states such as Texas, West Virginia, Florida, Delaware, and Colorado, highlight the feasibility of state-level implementation through shared governance, blood rotation strategies, and public investment. Overall, evidence supports the use of prehospital blood in selected populations, yet access remains limited and uneven. State-directed coordination represents a pragmatic framework to align existing blood centers, hospitals, and EMS agencies, although additional research, data integration, and national policy development are needed to guide broader implementation.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002321"},"PeriodicalIF":2.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immigration enforcement in hospitals: a framework for health systems.","authors":"Joseph V Sakran, Karey McDonough, Zakk Arciaga, Bellal Joseph","doi":"10.1136/tsaco-2026-002368","DOIUrl":"10.1136/tsaco-2026-002368","url":null,"abstract":"<p><p>Hospitals are intended to be spaces of diagnosis, treatment, and healing, yet health systems are increasingly confronting immigration enforcement activity in and around clinical settings, including emergency departments, inpatient units, and other restricted care areas. These encounters may introduce fear, operational uncertainty, and ethical tension for patients, families, clinicians, and institutional leaders. In high-acuity environments such as trauma bays, perioperative areas, and emergency departments, the presence of enforcement personnel may be particularly disruptive to rapid clinical decision-making, patient trust, and the delivery of uninterrupted care. This perspective article proposes a practical, nonpartisan framework to guide health system responses to immigration enforcement encounters in clinical spaces. The framework is grounded in core legal and ethical obligations, including protection of patient confidentiality, compliance with the Health Insurance Portability and Accountability Act, adherence to the Emergency Medical Treatment and Labor Act, and maintenance of clinical boundaries between public and non-public hospital areas. We outline a three-phase approach: preparation before an encounter occurs, a stepwise real-time response, and post-event support for patients and staff. Key recommendations include establishing a clear written policy, designating a 24/7 legal or administrative point of contact, training frontline staff not to make legal determinations, aligning electronic health record practices to minimize unnecessary documentation of immigration status, preserving clinical care during enforcement encounters, and using structured debriefings after events. A trauma-informed approach is essential, recognizing that enforcement activity may reinforce fear, institutional mistrust, and prior experiences of violence or coercion. By standardizing protocols and centering patient care, hospitals can protect confidentiality, support clinicians, reduce operational confusion, and preserve their fundamental mission as places of healing without fear or favor.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002368"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Not the basic ABC of how you control a blood vessel': perceptions of UK Defence Medical Services personnel toward live tissue training for the surgical management of trauma.","authors":"C S Swain, M G Harjani, G Helgesson, R F Rickard, K Karlgren","doi":"10.1136/tsaco-2026-002274","DOIUrl":"10.1136/tsaco-2026-002274","url":null,"abstract":"<p><strong>Introduction: </strong>'Live tissue training' (LTT) is simulation using live anaesthetized animals as human patient substitutes. The educational benefits specific to LTT are unclear. This study aimed to explore the perceptions and attitudes of UK Defence Medical Services (DMS) personnel toward the use of LTT in the surgical management of trauma.</p><p><strong>Methods: </strong>Five virtual focus groups were conducted, with 20 regular and reservist DMS personnel representing surgical specialties, anesthesia, emergency medicine and primary care. Participants discussed their experiences of LTT and the impact on their professional development. Systematic text condensation was used to thematically analyze transcribed data.</p><p><strong>Results: </strong>Six themes were constructed, titled: (1) <i>LTT: Who should do it and when;</i> (2) <i>conducting LTT as a military team;</i> (3) <i>psychomotor learning;</i> (4) <i>affective learning;</i> (5) <i>fidelity;</i> (6) <i>ethics and justification</i>. Differences in perspectives were noted for prehospital and secondary care learners - LTT is used to individually train primary care personnel and military medics in basic, initial trauma management skills; secondary care personnel consider LTT a 'finishing school' for experienced clinicians to practice rare and high-risk procedures, within a military team setting.</p><p><strong>Conclusion: </strong>DMS personnel report positively about LTT, consider it to be realistic (higher fidelity) simulation training, and have educational and moral rationales to justify its use. The educational attributes of LTT appear to be context-specific and dependent on DMS learner role. This knowledge should influence the design and delivery of military trauma simulation involving live animals, allowing for replacement, reduction and refinement in their use for training different cohorts of learners.</p><p><strong>Level of evidence: </strong>6 - qualitative research.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002274"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of survival after penetrating cardiac trauma: injury patterns and presentation factors.","authors":"Michelle Mendiola Pla, Jalia Anderson, Eliza Mundenmaney, Jeremy Miller, Holly Gui, Crystal Valdez, Grace Chang","doi":"10.1136/tsaco-2026-002237","DOIUrl":"10.1136/tsaco-2026-002237","url":null,"abstract":"<p><strong>Background: </strong>Penetrating cardiac trauma is associated with high mortality. Factors influencing survival remain incompletely characterized. This study aimed to identify injury patterns and presentation characteristics associated with survival after penetrating cardiac trauma at an urban, level 1 trauma center.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with penetrating cardiac trauma identified from the hospital trauma registry between 2017 and 2025. Patients with documented penetrating cardiac injury were included. Demographic, physiological, and injury characteristics were compared between survivors and non-survivors using the Mann-Whitney U test for continuous variables and Pearson's χ² test or Fisher's test for categorical variables. Univariate Firth's logistic regression was used to calculate ORs with 95% CIs.</p><p><strong>Results: </strong>Among 18 041 trauma activations, 57 patients with penetrating cardiac injury were identified. Overall survival was 25%. Gunshot wound (GSW) was the most common mechanism of injury (67%) and was associated with a higher risk of mortality compared with stab wound injuries (SWIs) (OR 3.70, 95% CI 1.10 to 12.1). Multichamber cardiac injury (OR 10.9, 95% CI 1.26 to 1439), thoracic vascular injury (OR 12.3, 95% CI 1.43 to 1615), and concurrent abdominal injury (OR 4.40, 95% CI 1.12 to 24.7) were associated with death. Conversely, isolated cardiac injury (OR 0.21, 95% CI 0.06 to 0.75), spontaneous respirations (OR 0.06, 95% CI 0.01 to 0.24), and signs of life on presentation (OR 0.01, 95% CI 0 to 0.10) were predicted survival.</p><p><strong>Conclusion: </strong>Penetrating cardiac trauma carries a high mortality rate. Survival was associated with SWI, preserved physiologic status on presentation, and injuries isolated to the heart, whereas GSW and concurrent thoracic vascular or abdominal injuries were associated with death. Recognition of these factors may assist clinicians in early triage and resuscitative decision-making.<i>Level of evidence</i>: level III, prognostic study.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002237"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Better way: initial acceptability testing of using artificial intelligence tools to accelerate development of trauma clinical guidance.","authors":"Gabriela Zavala Wong, Shannon Rosenauer, Chelsea Church, Diana Sherifali, Megan Racey, Katheryn Grider, Ashley N Moreno, Lacey LaGrone","doi":"10.1136/tsaco-2025-002060","DOIUrl":"10.1136/tsaco-2025-002060","url":null,"abstract":"<p><strong>Introduction: </strong>Representatives of the trauma community have voiced a need for a new approach to developing clinical guidance. In this study, we test the initial acceptability of a proposed 12-step approach that aims to reduce the current clinical guidance timeline from more than 24 months to 24 weeks.</p><p><strong>Methods: </strong>Investigators hypothesized that artificial intelligence (AI) tools could be leveraged to improve and make the process of clinical guidance development more efficient, facilitating AI initial output that could later be reviewed by subject matter experts (SMEs), ensuring ethical standards and a collaborative design. Following the agile methodology, emphasizing continuous delivery and improvement, and the Practical, Robust Implementation and Sustainability Model framework, the investigators drafted a 12-step approach to clinical guidance development in 24 weeks. The process begins with selecting a clinical topic and culminates in a bedside-ready clinical decision tree.</p><p><strong>Results: </strong>The 2025 <i>Design for Implementation: The Future of Trauma Research & Clinical Guidance</i> conference participants were invited to reflect on this new 12-step approach during two breakout sessions. Participants included a broad range of trauma providers, methodologists, patient representatives, technology, and marketing experts. Their recommendations highlighted: (1) multidisciplinary involvement, (2) need for resource-stratified guidance, and (3) user-friendly features (offline and multilingual access). On a postconference survey (n=56 total respondents), 64% were confident in AI accelerating the current development process.</p><p><strong>Conclusions: </strong>The current landscape of clinical guidance offers significant opportunities for improvement. Key areas for improvement include promoting collaboration across multiple disciplines and organizations, developing recommendations that consider resource variations, and leveraging new technologies, such as AI, to expedite the development process. This is crucial because ongoing delays lead to practices lagging behind current evidence. Further research is needed to rigorously test and refine how responsible use of AI can be integrated into expediting evidence integration into clinical guidance.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 5","pages":"e002060"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13296030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choices and support during serious illness in the surgical intensive care unit.","authors":"Sabrina E Sanchez, Danby Kang","doi":"10.1136/tsaco-2025-001848","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001848","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e001848"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workplace violence in trauma centers is a serious problem: an AAST Disaster Committee survey on assaults on trauma teams.","authors":"Amy E Liepert, Mary E Fallat, Jeannette M Capella, Adam D Fox, Deborah A Kuhls, Galina Glinik, Peter E Fischer, Jonathan D Gates, Nicole Toscano, Katherine Kelley, Sophie H Chung, Jay J Doucet, Aast Disaster Committee","doi":"10.1136/tsaco-2025-002167","DOIUrl":"10.1136/tsaco-2025-002167","url":null,"abstract":"<p><strong>Objective: </strong>Violence against healthcare workers (HCWs), especially in emergency departments and trauma centers (TCs), is a significant and growing problem. HCWs have the highest numbers and annual rates of workplace violence (WPV) compared with any other private industry sector. There is less information about the rates of violence and stalking against trauma providers in TCs. We hypothesized that a majority of trauma surgeons and team members have experienced deliberate assaults in their TCs. Our secondary hypothesis was that a majority of trauma providers consider WPV a significant issue in their workplace.</p><p><strong>Methods: </strong>The American Association for Surgery of Trauma Disaster Committee invited 2,100 members to participate in an online survey in May and July 2024. Questions evaluated practice type, TC characteristics, training, experience with WPV, beliefs about WPV prevention, and potential WPV prevention strategies interventions.</p><p><strong>Results: </strong>The survey response rate was 10.9%, yet the prevalence of WPV in TCs was reported to be high. 63.9% of respondents were aware of a deliberate assault on an HCW in their TC or system. 42.5% had been assaulted personally, and 7.5% suffered injury as a result of a deliberate assault. Respondents generally agreed on the need for WPV prevention measures such as prevention education, metal detectors, armed police, or security, and were aware of deaths and disabilities among HCWs after assaults. However, they did not personally see WPV as a significant issue in their TCs.</p><p><strong>Conclusions: </strong>There is a high prevalence of WPV with significant effects on the entire trauma workforce, including elevated levels of emotional distress, burnout, post-traumatic stress disorder, and long-term irreversible physical injuries and deaths. Respondents agreed on the need for preventive measures but did not view WPV as a major issue in their own TCs. Research into this discrepancy, as well as effective strategies to reduce WPV in TCs, would support advocacy for improved legislation and policies aimed at preventing WPV in healthcare.</p><p><strong>Level of evidence: </strong>V - Survey of expert opinion.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002167"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ostomy essentials: patient education series - understanding trauma and emergency surgery conditions.","authors":"Jaclyn N Portelli Tremont, Charlotte Blythe Smith, Jared Robert Gallaher","doi":"10.1136/tsaco-2025-001880","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001880","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e001880"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical complications in patients with severe traumatic brain injury during inpatient rehabilitation: a retrospective study.","authors":"Saumya Susan Zacharia, Raji Thomas","doi":"10.1136/tsaco-2025-001936","DOIUrl":"10.1136/tsaco-2025-001936","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) necessitates comprehensive inpatient rehabilitation for optimal outcomes, addressing challenges across physical, cognitive, and psychosocial domains. This study fills gaps in Indian literature by exploring medical complications during rehabilitation and correlating them with functional outcomes. Emphasizing the preventable nature of complications, our research underscores the importance of early diagnosis and interventions, contributing valuable insights to enhance TBI patient care in inpatient rehabilitation settings.</p><p><strong>Aim: </strong>To analyze medical complications during inpatient rehabilitation of patients with severe TBI during 2017-2019, exploring associations with patient demographics and injury characteristics.</p><p><strong>Materials and methods: </strong>This study included 100 individuals over 18 years, admitted following severe TBI (Glasgow coma scale (GCS) 3-8) for rehabilitation to the Department of Physical Medicine and Rehabilitation from 1 August 2017 to 31 August 2019. A retrospective analysis of their medical records, employing a structured questionnaire, was conducted.</p><p><strong>Results: </strong>Among 100 TBI patients, 81% were male, primarily aged 40-60 years (35%). The mean (SD) age was 35 (15.81) years, and the mean (SD) time since injury was 15.84 (26.13) months. Road traffic accidents accounted for 81% of injuries, with 39% admitted within 6 months. 87% of them had complications, predominantly neurobehavioral issues (35%) and heterotopic ossification (20%).</p><p><strong>Conclusion: </strong>Medical complications were prevalent in 87% of patients admitted for rehabilitation, showing associations with age, duration since injury, and level of consciousness. This study emphasizes the importance of regular medical input for individuals with TBI admitted for inpatient rehabilitation and the need for regular follow-up.</p><p><strong>Level of evidence: </strong>Level III, retrospective.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e001936"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}