Trauma Surgery & Acute Care Open最新文献

{"title":"How hospital-based violence prevention professionals work: a qualitative study.","authors":"Lars Erik Almquist, Ellen A Ahlness, Ali Rowhani-Rahbar, Sarah Cusworth Walker, Christian D Helfrich","doi":"10.1136/tsaco-2025-002050","DOIUrl":"10.1136/tsaco-2025-002050","url":null,"abstract":"<p><strong>Background: </strong>Hospital-based violence intervention programs (HVIP) hinge on the ability of violence prevention professionals to assist the recovery of intentionally injured patients to prevent further spread of violence. Yet, we know little about the tactics these professionals use or whether the tactics developed by one violence prevention professional transfer to another. To address these gaps, this research catalogs the tactics frontline professionals use to meet the recovery needs of violently injured patients.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 23 hospital-based violence prevention professionals to identify tactics used in everyday work. Interviews were organized around 10 \"hinge points\" on the patient's recovery continuum deemed integral to program success, identified a priori. The Action Actor Context Target Time (AACTT) rubric helped ascertain essential information about each tactic identified via inductive thematic analysis.</p><p><strong>Results: </strong>We identified 214 tactics used by violence prevention professionals. Tactics addressing the initial patient encounter (n=49), trustbuilding efforts with patients (n=44), and service navigation (n=39) represented the largest and most diverse share of tactics identified. Comparably few tactics engaged patient retention (n=11) or aftercare as patients exited the program (n=3).</p><p><strong>Significance: </strong>Dissemination of these tactics will strengthen the skillsets of current HVIP professionals, while enhancing the training of future violence prevention personnel. Findings may support the creation of practical, readily deployable toolkits to translate tactical insight to diverse contexts where HVIPs operate, including HVIPs not yet established.</p><p><strong>Level of evidence: </strong>VI: Evidence from a single descriptive or qualitative study.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 4","pages":"e002050"},"PeriodicalIF":2.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621526","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":"2026 Donald Trunkey Lecture: strengthening care for the injured globally: successes, challenges, opportunities.","authors":"Charles Mock","doi":"10.1136/tsaco-2026-002462","DOIUrl":"10.1136/tsaco-2026-002462","url":null,"abstract":"<p><p>Trauma is a major health problem, killing 4.5 million people each year. Most (84%) of these deaths are in low- and middle-income countries (LMICs), where resources for trauma care are constrained, often severely. These resource constraints lead to discrepancies in outcomes, with higher case-fatality rates for similar injuries in LMICs compared with high-income countries. Over one million trauma deaths could be averted each year if case-fatality rates in LMICs could be brought down to high-income country levels. There have been many local examples of affordable and sustainable improvements in trauma care and trauma outcomes in LMICs. The WHO and professional societies have worked to make more sustained progress globally. These efforts have resulted in moderate improvements in the availability of resources for trauma care, as assessed by consensus panels over the past 20 years. During this time, mortality for trauma has declined by 24% in the richer half of the world (high-income and upper middle-income countries) and by 15% in the poorer half (low-income and lower middle-income countries). To make further progress, there are several priorities (long-term efforts that probably require significant investment and new technology) and opportunities (which are immediately actionable). Priorities include increased availability of blood; improved care for traumatic brain injury; and improved prehospital care. Several opportunities are calling out for immediate action: increased use of trauma short courses and quality improvement programs; development of an international trauma registry for benchmarking; and use of the newly updated edition of the International Association for Trauma Surgery and Intensive Care's <i>Guidelines for Essential Trauma Care</i> for needs assessments of trauma care resources, with advocacy to fill identified gaps.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002462"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608001","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":"Using geographic information systems to identify Stop the Bleed training locations.","authors":"Anna E Garcia Whitlock, Daniela Schmulevich, Elinore J Kaufman, Justin S Hatchimonji, Karina M Hiroshige, Mark J Seamon, Daniel N Holena, John J Gallagher, Patrick M Reilly, Jeremy W Cannon, Shariq S Raza","doi":"10.1136/tsaco-2025-002017","DOIUrl":"10.1136/tsaco-2025-002017","url":null,"abstract":"<p><strong>Objectives: </strong>The Stop the Bleed (STB) Campaign seeks to minimize preventable deaths from hemorrhage by educating community members on how to respond to life-threatening bleeding. A persistent challenge is connecting the training to individuals most at risk of witnessing a bleeding event. We hypothesize that geographic information system (GIS) software can identify STB training locations in at-risk communities and that trained individuals will be willing to respond to a bleeding event.</p><p><strong>Methods: </strong>Publicly available shooting locations in a large urban city with a high violent crime rate were assessed for spatial clustering using ArcGIS to map \"hot spots.\" Community training locations were colocalized on this map to identify sites in areas more likely to experience a violent event. Of eight high-risk sites identified, two were receptive to hosting a STB course, and one was chosen. Skills, knowledge, and attitudes were assessed precourse and postcourse. Knowledge, attitudes, and real-world tourniquet use were also evaluated at 1-month and 12-months.</p><p><strong>Results: </strong>15 community members were trained at one community center within an area with a high violent crime rate. As expected, skills improved significantly from precourse to postcourse as did knowledge. Knowledge remained improved at 1-month and 12-months compared with pre-course. Attitudes toward responding to life-threatening bleeding were more positive after the training and remained more positive at follow-up. None of the participants applied a tourniquet within 12-months of the STB course.</p><p><strong>Conclusions: </strong>GIS software can identify STB training sites within high-risk communities with a receptive audience as evidenced by durable knowledge retention and favorable attitudes toward controlling hemorrhage. Future efforts should seek to identify barriers to community training site participation in STB and to further leverage GIS software to identify and train individuals most likely to be present at a life-threatening bleeding event.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological, Level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002017"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607747","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":"Bayesian analysis of the early cold stored platelet transfusion following severe injury randomized clinical trial.","authors":"Justin Gerard, Jason L Sperry, Francis X Guyette, Bedda L Rosario-Rivera, Matthew E Kutcher, Lucy Kornblith, Bryan A Cotton, Chad T Wilson, Kenji Inaba, Laura Vincent, Ashley M Harner, Matthew D Neal, Stephen R Wisniewski, Brian Daley, Catherine McKnight","doi":"10.1136/tsaco-2025-002145","DOIUrl":"10.1136/tsaco-2025-002145","url":null,"abstract":"<p><strong>Background: </strong>The Early Cold Stored Platelet Transfusion Following Severe Trauma Injury Trial evaluated the safety and efficacy of cold stored platelet (CSP) transfusion in injured patients at risk of hemorrhagic shock. It was a phase II, multicenter, randomized clinical trial conducted from June 2022 to September 2023 at five US level 1 trauma centers. A total of 200 adult patients at risk of hemorrhagic shock (102 CSP, 98 standard care (SC)) were included. Median age was 34±13 years, 85% were males, and injury severity was similar between groups. The original frequentist analysis did not demonstrate a statistically significant difference in 24-hour mortality between CSP (5.9%) transfusion and SC (10.2%, p=0.28).</p><p><strong>Methods: </strong>To provide further insight into these findings, a Bayesian logistic regression outcome model with an uninformative prior was performed. To validate the findings further, a sensitivity analysis was performed in addition to analysis using a beta-binomial Bayesian model.</p><p><strong>Results: </strong>The Bayesian logistic regression model yielded an 89.1% posterior probability that CSP transfusion reduced 24-hour mortality (ß₁=-0.668, 95% highest posterior density interval: -1.7 to 0.48). This posterior distribution indicates it is 8.1 times more likely that CSP transfusion improves 24-hour mortality than not. Sensitivity analyses across a spectrum of priors consistently produced posterior probabilities >81%. The beta-binomial model demonstrated a similar 86.2% probability that CSP transfusion reduced 24-hour mortality.</p><p><strong>Conclusion: </strong>These findings suggest a high likelihood of mortality benefit with early CSP transfusion in injured patients at risk of hemorrhagic shock and illustrate the added interpretive value of Bayesian analysis in trauma trials with low event rates.</p><p><strong>Level of evidence: </strong>Level II-therapeutic/care management.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002145"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607954","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":"Impact of a rib fracture treatment protocol: a propensity score matching analysis.","authors":"Thermutis Djanie, Ashley Pfaff, Claire Miller, Ashar Ata, Allan E Stolarski, Lauren Evans, Carl Rosati, Matthew Johnson, Ashley Bartscherer, Steven C Stain, Marcel Tafen","doi":"10.1136/tsaco-2025-001989","DOIUrl":"10.1136/tsaco-2025-001989","url":null,"abstract":"<p><strong>Background: </strong>Rib fractures (RFx) increase morbidity, mortality, and resource utilization. This retrospective study aimed to evaluate the effectiveness of a novel RFx treatment protocol (RFTP) on patient outcomes.</p><p><strong>Study design: </strong>We included 3679 RFx patients admitted to a single level 1 trauma center between January 2011 and October 2018. The RFTP, launched as a computer physician order entry on October 25, 2016, included an escalating multimodal pain management, a standardized nursing assessment with interventions, and an atelectasis and mucus clearance regimen. Patients' characteristics and outcomes before and after the protocol were compared. Propensity score matching analysis was used to account for differences in baseline characteristics between groups. Intention-to-treat and protocol analyses were done. Outcome measures included mortality, length of stay (LOS), pulmonary complications, rapid response activations, and elevation in level of care.</p><p><strong>Results: </strong>There were 2393 and 1286 patients treated in the pre-protocol and post-protocol time periods, respectively. Adherence rate to the RFTP was 53.3%. Multivariate adjustment showed a significant reduction in hospital LOS by 1.4 days (95% CI 0.71 to 2.02), a significant decrease in the odds of requiring mechanical ventilation (OR 0.77, 95% CI 0.58 to 1.00) and rapid responses (OR 0.55, 95% CI 0.42 to 0.72). Comparison of the matched samples also showed a significant decrease in LOS (14.7 days vs 11.2 days, p<0.001), rapid responses (17.7% vs 12.8%, p=0.010), and mortality (10.7% vs 6.5%) in those treated using the RFTP in the post-protocol period. These findings were mostly substantiated on per-protocol analyses.</p><p><strong>Conclusion: </strong>The RFx protocol was associated with significant improvements in the LOS and a reduction in rapid responses required. In a severely morbid matched sample, the RFTP was also associated with reduced mortality. Multidisciplinary protocolized care of patients with RFx is associated with better outcomes.</p><p><strong>Level of evidence: </strong>Level III evidence (retrospective cohort study).</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001989"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550605","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 immigration policy meets the bedside: operationalizing care and compliance.","authors":"David Zonies","doi":"10.1136/tsaco-2026-002449","DOIUrl":"10.1136/tsaco-2026-002449","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002449"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550775","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":"You Can't Clamp What You Can't Find.","authors":"Mark Bowyer, Pamela B Andreatta, Matthew Bradley","doi":"10.1136/tsaco-2026-002479","DOIUrl":"10.1136/tsaco-2026-002479","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002479"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550699","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":"Heart of the matter: the physiology that determines survival.","authors":"Allan E Stolarski, Mark J Seamon","doi":"10.1136/tsaco-2026-002460","DOIUrl":"10.1136/tsaco-2026-002460","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002460"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550638","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":"Detecting infection after trauma: why clinical context still matters.","authors":"Mariaelena A Boyle, Pauline K Park","doi":"10.1136/tsaco-2026-002504","DOIUrl":"10.1136/tsaco-2026-002504","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002504"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550671","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":"Military medical readiness cannot be created on demand: a 'Seaworthy' test of the Military Health System's flagship.","authors":"Jan-Michael Van Gent, Carter Kaminski, Jennifer Gurney","doi":"10.1136/tsaco-2026-002480","DOIUrl":"10.1136/tsaco-2026-002480","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002480"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550758","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}