Trauma Surgery & Acute Care Open最新文献

{"title":"Researcher's guide to preclinical animal models of acute extremity compartment syndrome.","authors":"Catharina Constanze Gaeth, Robert Joseph Moritz, Max Seidelmann, Daniel Joseph Cognetti","doi":"10.1136/tsaco-2025-001754","DOIUrl":"10.1136/tsaco-2025-001754","url":null,"abstract":"<p><p>Acute extremity compartment syndrome (CS) is a serious medical complication triggered by factors such as trauma, vascular injury, or prolonged compression, resulting in elevated intracompartmental pressure (ICP) and tissue ischemia. Diagnosis remains challenging, mainly relying on the subjective evaluation of clinical symptoms. Different animal models have been used to study pathophysiology and evaluate diagnostic and therapeutic approaches. The aim of this review is to summarize and compare different animal CS models to provide insight for the development of more authentic and clinically relevant CS model. A comprehensive search of two databases was conducted. English-language animal studies focusing on CS were included. Human studies, non-acute extremity CS, and review papers were excluded. Data extraction and analysis focused on animal species, CS models, and clinically relevant assessment methods of CS. After screening, 90 studies met the inclusion criteria. Small animal (n=36, 40%) and canine models (n=31, 34.4%) were the most used animal species. A fluid infusion model (n=48, 53.3%) was the predominant induction method, followed by the ischemia-reperfusion (n=29, 32.2%) and the internal/external mechanical pressure models. Five studies used a combination CS model to achieve a more comprehensive representation of the clinical pathophysiology. Various diagnostic modalities were employed; ICP measurement (n=74, 82.2%) and evaluation of tissue oxygenation (n=10, 11.1%) were the most frequent device-based assessments. Biomarkers assessing muscle cell damage (n=15, 16.7%), antioxidant status (n=18, 20%) and inflammation (n=16, 17.8%) were analyzed as well as physical examination (n=12, 13.3%) and neuromuscular testing (n=10, 11.1%). There are a variety of validated animal species models, which can be considered depending on the research objectives. This review helps researchers evaluate model strengths and drawbacks before deciding on an experimental design.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 5","pages":"e001754"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024223","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":"The <i>Design for Implementation: The Future of Trauma Research and Clinical Guidance</i> (DFI) Conference Series Editorial.","authors":"Kelly L Lang, Pamela J Bixby, Michelle A Price, Cynthia Lizette Villarreal, Ashley N Moreno, Lacey N LaGrone","doi":"10.1136/tsaco-2024-001582","DOIUrl":"10.1136/tsaco-2024-001582","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 5","pages":"e001582"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041348","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":"TRAUMA: making trauma clinical guidance more implementable.","authors":"Danielle J Wilson, Gabriela Zavala Wong, Christopher Tignanelli, Mary Nix, Ashley N Moreno, Lacey N LaGrone","doi":"10.1136/tsaco-2024-001610","DOIUrl":"10.1136/tsaco-2024-001610","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma clinical guidance (guidelines, protocols, algorithms, etc) has been shown to improve patient outcomes; however, it is only used in about half of the patients to whom it applies. Guidance implementation is affected by intrinsic factors (eg, guidance format) as well as extrinsic factors (eg, the clinical environment). Recommendations and frameworks have been created to aid in the development of implementable guidance. We hypothesize that existing trauma clinical guidance lacks elements important for implementation.</p><p><strong>Methods: </strong>The Framework for Guideline Implementability by Gagliardi, which consists of 22 elements arranged into eight domains, was used to evaluate trauma clinical guidance. A sample of 20 pieces of guidance, crafted by 11 professional organizations, were reviewed. Data were extracted to identify the presence or absence of each implementability element.</p><p><strong>Results: </strong>All guidance provided a clear objective and 85% allowed for individualized application of recommendations based on clinical scenario. Approximately half of the guidance included formatting elements, such as graphic aids, to enhance usability, and 50% incorporated formal evidence grading. Patient-friendly tools accompanied 10% of guidance, and few discussed implementation strategies (25%) or quality metrics (30%) to evaluate guidance implementation.</p><p><strong>Discussion: </strong>Clinical guidance exists on a spectrum, from narrative (eg, written documents) to executable tools (eg, automated decision support based on patient context). While integration of computable guidance into clinical workflows may be the ultimate goal in high-resource settings, there are other more feasible and even cost-free modifications developers may integrate into new guidance to improve implementation across settings.</p><p><strong>Conclusion: </strong>Utilization of trauma clinical guidance is crucial for improving healthcare quality. To achieve this, guidance developers might leverage the elements in the new TRAUMA (Transparency, Robust inclusivity, Adaptability, Usability, Measurability, Accessibility) framework that enhance implementability. Future research is needed to validate this theoretical new framework's impact on clinical implementation and patient outcomes.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 5","pages":"e001610"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024261","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":"Reply to the reader requesting a response to the scoping review exclusion of the abdominal aortic junction tourniquet.","authors":"Donald Adams, Paige L McDonald, Seth Holland, Philip van der Wees","doi":"10.1136/tsaco-2025-002038","DOIUrl":"10.1136/tsaco-2025-002038","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e002038"},"PeriodicalIF":2.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024306","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":"Comment on: 'Management of non-compressible torso hemorrhage of the abdomen in civilian and military austere environments: a scoping review'.","authors":"Paul Parker","doi":"10.1136/tsaco-2025-001934","DOIUrl":"10.1136/tsaco-2025-001934","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001934"},"PeriodicalIF":2.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024298","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":"Moving the needle on minimum standards: alcohol's dose-dependent association with reinjury is worthy of targeted intervention.","authors":"Rishi Rattan","doi":"10.1136/tsaco-2025-002012","DOIUrl":"10.1136/tsaco-2025-002012","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e002012"},"PeriodicalIF":2.2,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001112","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":"Making a 'spleen getaway': no infectious association or chasing the diagnosis?","authors":"Michael J Littau, Natalia Zofia Ochman, Jeffrey A Claridge","doi":"10.1136/tsaco-2025-001965","DOIUrl":"10.1136/tsaco-2025-001965","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001965"},"PeriodicalIF":2.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970199","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":"When falling becomes a pattern: reframing recidivism in the geriatric trauma population.","authors":"Jacqueline Dalfen, Jeremy Grushka, Evan G Wong","doi":"10.1136/tsaco-2025-001951","DOIUrl":"10.1136/tsaco-2025-001951","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001951"},"PeriodicalIF":2.2,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970326","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":"Time sequence of bacterial and fungal pathogens causing infections in trauma patients.","authors":"Frederique J C van Eerten, Miquel B Ekkelenkamp, Joost D J Plate, Emma J de Fraiture, Loulou V Duebel, Nienke Vrisekoop, Karlijn J P van Wessem, Leo Koenderman, Falco Hietbrink","doi":"10.1136/tsaco-2025-001859","DOIUrl":"10.1136/tsaco-2025-001859","url":null,"abstract":"<p><strong>Purpose: </strong>A time sequence occurs in pathogens leading to infections in Intensive Care Unit (ICU) patients with a compromised immune system. A similar pattern may also occur in (multi)trauma patients characterized by similar impaired immunological responses. Such immune malfunction might be prolonged and enable hospital-acquired pathogens (selected through antibiotic regimens) to cause infections. This study investigated the timing of infections and associated pathogens in severely injured trauma patients.</p><p><strong>Methods: </strong>A retrospective, single-center cohort study was conducted at a level-1 trauma center. Severely injured trauma patients from 2013 to 2022 with an ICU stay >48 hours were included. Infections compliant with the criteria of the Centers for Disease Control and Prevention and causative pathogens were documented. Timing of infections was scored as days after trauma.</p><p><strong>Results: </strong>109 out of 572 severely injured trauma patients developed infectious complications. All patients received antibiotics. A time sequence of pathogens that caused infections was observed. <i>Staphylococcus aureus</i>, <i>Enterococcus</i> spp., and CoNS were mainly responsible for infections before day 40 after trauma. From day 60 onward<i>, Klebsiella</i> spp., <i>Candida</i> spp.<i>, Enterobacter</i> spp.<i>, and Pseudomonas</i> spp. became more frequent.</p><p><strong>Conclusion: </strong>A time sequence in occurrence of pathogens and associated infections was found in severely injured trauma patients. Commensal micro-organisms were predominant in the first weeks after trauma, which shifted toward hospital-acquired microorganisms over time. This observed time sequence is consistent with the hypothesis that a long-term imbalanced innate immune system facilitates infections with these normally non-pathogenic organisms during months after severe trauma.</p><p><strong>Level of evidence: </strong>This was a retrospective cohort study with level III evidence.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001859"},"PeriodicalIF":2.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970270","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":"Role of blood alcohol level on the risk and severity of trauma recurrence.","authors":"Steven Char, Bharti Sharma, Monique Arnold, George Agriantonis, Jennifer Whittington, Navin Bhatia","doi":"10.1136/tsaco-2024-001743","DOIUrl":"10.1136/tsaco-2024-001743","url":null,"abstract":"<p><strong>Background: </strong>Alcohol intoxication at the time of index trauma is associated with an increased risk of recurrent traumatic injury. It is unclear, however, whether the degree of intoxication impacts the risk of recurrence or its severity. This study aimed to analyze the relationship between alcohol level at index trauma and risk of recurrent trauma. We hypothesized that increasing levels of alcohol would be associated with an increased risk of trauma recurrence and severity.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults who presented to our Level 1 trauma center between January 2020 and December 2022 with traumatic injury and a positive alcohol level (blood alcohol content (BAC)). The primary outcome of interest was recurrent trauma within 12 months. Secondary outcomes included injury severity score, hospital length of stay, and discharge location. We performed univariable and multivariable logistic regression with class balancing sensitivities controlling for baseline patient characteristics to analyze the association between risk factors and trauma recurrence.</p><p><strong>Results: </strong>Of the 1,653 trauma encounters across 1,585 patients included in this study, 63 patients (3.8%) experienced re-injury within 12 months. Mean BAC at index trauma was higher among the recurrently injured compared with non-recurrently injured patients (270.0 mg/dL vs 221.0 mg/dL, p<0.001). Multivariate analysis revealed that for all-comers increasing BAC was weakly associated with an increased risk of trauma recurrence (OR 1.004, 95% CI: 1.001 to 1.007, p=0.013), but that among the highest tertile of intoxicated patients, increasing BAC was strongly associated with recurrence (OR 2.607, 95% CI: 1.166 to 6.448, p=0.026). Recurrently injured patients were more likely to have at least one medical comorbidity.</p><p><strong>Conclusions: </strong>We found a differential effect of alcohol intoxication on the risk of trauma recurrence whereby increasing BAC was strongly associated with an increased risk of recurrence only among the most intoxicated patients.</p><p><strong>Level of evidence: </strong>III, Prognostic and epidemiological.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001743"},"PeriodicalIF":2.2,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883840","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}