Trauma Surgery & Acute Care Open最新文献

{"title":"Improving trauma care in Pakistan: a need for intervention-based studies.","authors":"Justine Broecker, Saad Liaqat Sahi","doi":"10.1136/tsaco-2026-002314","DOIUrl":"10.1136/tsaco-2026-002314","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002314"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550682","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 just another blocked pipe: the trouble with 'door-to-needle' trauma metrics.","authors":"Clifford R Weiss, Karan Rao","doi":"10.1136/tsaco-2026-002455","DOIUrl":"10.1136/tsaco-2026-002455","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002455"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550780","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":"Flagship response: a descriptive analysis of definitive surgical care at the Walter Reed National Military Medical Center following the Afghanistan withdrawal.","authors":"Mason Remondelli, Natalia Barzanji, Vera Funk, Kennedy Nye, Jonathan Wang, Joseph Bozzay, Patrick Walker, Ruby Runikera, Judy Logeman, Elliot Jessie, Ashley Humphries, Eric Elster, Matthew Bradley","doi":"10.1136/tsaco-2025-001976","DOIUrl":"10.1136/tsaco-2025-001976","url":null,"abstract":"<p><strong>Objectives: </strong>We descriptively analyzed the trauma care outcomes of combat casualties arriving at the Walter Reed National Military Medical Center (WRNMMC) following the 2021 Afghanistan withdrawal as part of process improvement (PI) initiatives and quality assurance.</p><p><strong>Methods: </strong>A retrospective review of casualty records within the trauma registry at WRNMMC was conducted. The review included all patients who required definitive surgical intervention or critical care at WRNMMC from injuries sustained during the Afghanistan withdrawal. Data abstraction involved a detailed review of electronic medical records to document patient demographics, injury mechanisms, Injury Severity Scores (ISSs), operative reports, perioperative complications, and outcomes.</p><p><strong>Results: </strong>A total of 50 casualties were received at WRNMMC after the Afghanistan withdrawal, including 17 US military service members and 33 Afghan evacuees (20 adults and 13 pediatric). The mean ISS for US service members was 16.3±14.3. The mean ISS of Afghan evacuees was 10.7±6.1 for adults and 16.6±13.3 for pediatric evacuees. Polytrauma was common, with a majority of casualties sustaining injuries to multiple body regions. A total of 234 injuries were seen, with an average of 4.68±3.8 injuries per casualty. 264 operations were performed, averaging 5.2±5.6 per casualty. 23 postsurgical complications occurred in 10 casualties. 28 PI filters were initiated on 22 casualties. Caring for the casualties required multidisciplinary cooperation led by the trauma and acute care surgery service.</p><p><strong>Conclusion: </strong>The trauma care provided at WRNMMC following the Afghanistan withdrawal demonstrated institutional readiness and effective multidisciplinary coordination, but with a sizable burden of postoperative complications and PI filters. Lessons from this experience highlight the importance of continuous PI to optimize care delivery and outcomes, and underscore the need to sustain WRNMMC and strengthen other casualty-receiving Military Treatment Facilities to preserve trauma care readiness for future conflict.</p><p><strong>Level of evidence: </strong>Therapeutic/care management; level V.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001976"},"PeriodicalIF":2.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608052","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":"An exponential increase in e-bike injuries in California.","authors":"John Austin, Louis Perkins, Laura N Haines, Leslie Kobayashi, Allison E Berndtson, Jessica L Weaver, Jarrett Santorelli, John Maa, Romeo C Ignacio, Sigrid Burruss, Amy E Liepert, Todd W Costantini, Jay J Doucet","doi":"10.1136/tsaco-2025-002099","DOIUrl":"10.1136/tsaco-2025-002099","url":null,"abstract":"<p><strong>Background: </strong>Electric bicycle (e-bike) sales are growing exponentially worldwide. These vehicles are faster and heavier, with younger riders using e-bikes more frequently, reports of inconsistent helmet use, and increased deaths and injuries. We hypothesized that California has experienced significant annual increases in e-bike rider injuries and injury severity compared with injured traditional bicyclists, using a transportation injury registry and geospatial mapping system, including socioeconomic factors.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the California Highway Patrol Statewide Integrated Traffic Records System (SWITRS) from 2018 to 2024, identifying e-bike collisions through reporter coding and vehicle brand names. We analyzed demographics, injury severity, fault status, traffic violations, and scene census tract Social Vulnerability Index (SVI). All non-e-bike traditional bicycle collisions served as the comparison group.</p><p><strong>Results: </strong>We identified 4035 e-bike and 58 332 bicycle collisions. E-bike injuries increased sharply over the study period, from two incidents in 2018 to 1566 in 2024 (p<0.001), while bicycle collisions remained stable. E-bike riders were younger (median 33 vs 36 years; p<0.001), with a significantly greater proportion aged ≤14 years (15.6% vs 10.2%). Moderate-to-severe injuries were more common among e-bike riders (15.8% vs 11.9%; p<0.001). Although overall mortality was similar (2.0% vs 1.7%), a significant divergence emerged in 2024, with higher e-bike mortality (p=0.027) and a significant interaction between year and vehicle type. E-bike collisions demonstrated more unsafe speed and improper turning violations and occurred in census tracts with lower social vulnerability. Spatial analysis showed tighter clustering of e-bike collisions relative to bicycles.</p><p><strong>Conclusions: </strong>E-bike injuries are rapidly increasing in California and are associated with a higher severity of injuries compared with traditional bicycles. Urgent efforts are needed for targeted prevention, regulatory alignment, and rider education.</p><p><strong>Level of evidence: </strong>Level III, retrospective case-control study.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002099"},"PeriodicalIF":2.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607929","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":"Limb salvage versus primary amputation in severe lower extremity trauma: a systematic review and meta-analysis.","authors":"Javad Salimi, Saeed Soltani Asl Heris, Amir Shokri, Mahfam Nikzamir, Mohammad Amin Noroullahi","doi":"10.1136/tsaco-2025-002211","DOIUrl":"10.1136/tsaco-2025-002211","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The optimal management of severe lower extremity trauma remains controversial, with debate between limb salvage and primary amputation. Recent evidence synthesis is needed to guide clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare functional outcomes, quality of life, complications, and economic factors between limb salvage and primary amputation in severe lower extremity trauma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Electronic searches of five databases (PubMed, Embase, Cochrane CENTRAL, Scopus, Web of Science) from January 2000 to January 2025, supplemented by hand-searching of reference lists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study eligibility criteria participants and interventions: &lt;/strong&gt;Eligible studies were randomized controlled trials and prospective and retrospective cohort studies with a minimum 12-month follow-up assessing severe lower limb trauma (Gustilo-Anderson IIIB/IIIC or MESS (Mangled Extremity Severity Score) ≥7). Interventions were limb salvage compared with primary amputation. Forty-seven studies involving 8742 patients (4318 limb salvage, 4424 amputation) were identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study appraisal and synthesis methods: &lt;/strong&gt;Systematic review and meta-analysis conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Risk of bias assessed using ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions); certainty of evidence evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Quality of life metrics showed no clinically meaningful differences at 2-year follow-up (Short Form-36 (SF-36) Physical Component Summary: standardized mean differences (SMD) 0.16, p=0.0001; EQ-5D: SMD 0.07, p=0.31). Functional outcomes were comparable between groups (SMD 0.12, p=0.09). Limb salvage demonstrated modestly higher return-to-work rates (risk ratio (RR) 1.08, p=0.03) but required 4.7 months longer recovery. However, limb salvage was associated with significantly higher complications: 2.5-fold increased infection rates (RR 2.54, p&lt;0.001), 87% higher re-hospitalization (RR 1.87, p&lt;0.001), and 34% increased chronic pain prevalence (RR 1.34, p&lt;0.001). Secondary amputation occurred in 22.7% of salvage attempts. Initial healthcare costs were significantly higher for salvage (mean difference $28 600, p&lt;0.001), converging over 15+ years. Psychological outcomes were comparable between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The evidence base was predominantly observational, limiting causal inference, and residual confounding by injury severity and patient selection could not be excluded. Outcome measurement was heterogeneous across studies, and most studies originated from high-income countries, limiting generalisability to resource-limited settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions or implications of key findings: &lt;/strong&gt;Long-term functional outcomes and qua","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002211"},"PeriodicalIF":2.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607137","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 the need for angioembolization in blunt pelvic trauma.","authors":"Michele Fiorentino, Ruoying Li, Fei Ye, Rebecca Irlmeier, Rachel D Appelbaum","doi":"10.1136/tsaco-2025-002100","DOIUrl":"10.1136/tsaco-2025-002100","url":null,"abstract":"<p><strong>Background: </strong>Vascular injury following blunt pelvic fractures is a major source of morbidity and mortality. Angioembolization has become the standard of care for patients with contrast extravasation (CE) on CT scan; however, there are patients without CE who have a vascular injury. We aimed to determine the predictors of the need for angioembolization in patients with blunt pelvic fractures.</p><p><strong>Methods: </strong>We performed a retrospective case-control study of blunt trauma patients with pelvic fractures who underwent angiography by interventional radiology (IR) at a single institution from 2018 to 2023. Patients with CE on CT scan were compared with patients without CE to determine the risk factors for a positive angiogram. A multivariable logistic regression analysis was conducted to assess the factors associated with having a positive angiogram.</p><p><strong>Results: </strong>167 patients with blunt pelvic fractures underwent angiography: 120 with CE and 47 without CE on CT scan. Both groups were severely injured with a mean Injury Severity Score of 31; over 85% of patients requiring blood prior to angiography and 45% requiring massive transfusion protocol (MTP). There was no difference in rates of positive angiogram between patients with and without CE on CT scan (83% vs. 93%, p=0.08). Of the 47 patients without CE on their CT scan, 27 (57%) had active extravasation on angiography and an additional 12 (26%) had an injury requiring intervention. Initial systolic blood pressure, receiving blood prior to angiography, MTP activation, and CE on initial CT scan were not independently predictive of positive angiogram.</p><p><strong>Conclusion: </strong>Although CE on CT scan is often the initial trigger for IR consultation for angiography in trauma patients with pelvic fractures, there are patients without CE who have an injury requiring intervention. In trauma patients with concerns for ongoing hemodynamic instability, IR consultation is reasonable even without CE on initial CT scan.</p><p><strong>Level of evidence: </strong>Diagnostic test/criteria: level IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002100"},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607682","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":"Forging the frontlines at home: integrating military-civilian systems for national readiness and resilience.","authors":"Joshua Dilday, Christopher B Horn, Adam D Fox, Jay Johannigman, Jennifer Margaret Gurney, Brian Eastridge, Valerie G Sams, Jeffrey David Kerby, Rachel M Russo, Samir M Fakhry, Justin P Fox, Ryan Earnest, Jeffrey Bailey, Jay A Yelon","doi":"10.1136/tsaco-2026-002385","DOIUrl":"10.1136/tsaco-2026-002385","url":null,"abstract":"<p><p>Future large-scale combat operations, high-impact domestic disasters, and infrastructure-disrupting crises will generate casualty volumes and system stress far exceeding those experienced during the conflicts occurring during the previous two decades. These threats will transcend the traditional distinctions between military and civilian healthcare systems. They will necessitate an integrated national response capable of absorbing sustained casualty surges and preserving access to care for the civilian population. At the 2026 Eastern Association for the Surgery of Trauma Annual Scientific Assembly, a multidisciplinary short course entitled \"Forging the Frontlines at Home: Integrating Military-Civilian Systems for National Readiness and Resilience\" convened military, civilian, academic, and policy leaders to examine readiness gaps and propose actionable pathways to facilitate military-civilian integration. This article synthesizes key themes from that program across three domains: (1) defining the operational problem space, (2) coordinating a synchronized national response, and (3) understanding the financial and administrative consequences of large-scale casualty care. Together, these perspectives highlight that national casualty readiness for combat casualty care needs to be a core component of domestic resilience.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002385"},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606955","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":"Patterns in withdrawal of life-sustaining treatment in trauma patients with and without moderate to severe traumatic brain injury: an ACS-TQIP retrospective cohort study.","authors":"Nicole Russell, Alexander L Eastman, Jennifer L Grant","doi":"10.1136/tsaco-2026-002251","DOIUrl":"10.1136/tsaco-2026-002251","url":null,"abstract":"<p><strong>Background: </strong>Trauma-specific palliative care guidelines are limited, and physicians rely heavily on experience to guide goals-of-care discussions, leading to substantial practice variation. Existing literature does not adequately account for the marked heterogeneity among trauma patients. How traumatic brain injury influences the timing and determinants of delayed withdrawal of life-sustaining treatment in patients with concomitant major extracranial injuries remains poorly understood.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients ≥16 years with withdrawal of life-sustaining treatment in the American College of Surgeons Trauma Quality Improvement Program database (2021-2023). Patients were stratified by the presence of moderate to severe traumatic brain injury. The primary outcome was time to withdrawal of life-sustaining treatment. Our secondary aim was to assess predictors of delayed withdrawal (>75th percentile for each group) using separate binary logistic regression models.</p><p><strong>Results: </strong>Among 41 990 patients, 23 101 (55%) had a moderate to severe traumatic brain injury. Withdrawal occurred earlier in patients with moderate to severe traumatic brain injury (median 4 days (IQR 2-9) vs. 6 days (3-12), p<0.0001). The probability of delayed withdrawal increased non-linearly with increasing complication burden, plateauing near 100% after seven complications, with the first four having the greatest marginal effect. In patients with moderate to severe traumatic brain injury, unique predictors of delayed withdrawal included diffuse axonal injury, decompressive surgery, and intracranial pressure monitoring. The only major extracranial injury with predictive value was major chest injury (OR 1.3, 95% CI 1.1 to 1.4, p<0.001).</p><p><strong>Conclusions: </strong>Withdrawal of life-sustaining treatment occurs earlier in patients with moderate to severe traumatic brain injury and appears to be driven by distinct factors. Complications may serve as practical triggers for goals-of-care discussions. In polytrauma patients with moderate to severe traumatic brain injury, withdrawal decisions appear to be predominantly influenced by factors related to neurological injury. These findings support pursuing a more nuanced approach to palliative care research in the trauma intensive care unit.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002251"},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607694","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":"Machine learning for prehospital prediction of trauma-induced coagulopathy: a national evaluation of the potential impact on tranexamic acid administration.","authors":"Jared M Wohlgemut, Ateeq Almuwallad, Evangelia Kyrimi, Andrea Rossetto, Max E R Marsden, Erhan Pisirir, Rebecca S Stoner, Elaine Cole, William Marsh, Zane B Perkins, Nigel R M Tai, Ross Davenport","doi":"10.1136/tsaco-2026-002245","DOIUrl":"10.1136/tsaco-2026-002245","url":null,"abstract":"<p><strong>Background: </strong>Trauma-induced coagulopathy (TIC) is characterized in part by hyperfibrinolysis. Inhibiting fibrinolysis with tranexamic acid (TXA) decreases mortality in trauma patients, with greater benefit the earlier it is given. However, identifying which patients could benefit has been the subject of controversy. Machine learning models that predict TIC early after injury may aid clinician decision-making. The aim of this study was to identify the proportion of patients with different risks of developing TIC based on TIC-Bayesian network (BN) who received TXA within 1 hour of injury.</p><p><strong>Methods: </strong>This retrospective cohort study included all prospectively-collected adult patients in the UK Trauma Audit Research Network database, between 2015 and 2019, who received hemorrhage control interventions or blood transfusions. Patients were risk-stratified using TIC-BN. Patients were categorized by whether they received TXA ≤1 hour from injury, 1-3 hours from injury, >3 hours from injury, or did not receive it.</p><p><strong>Results: </strong>Of 27,272 included patients, median age was 51 years (IQR 32-71), 68% were male, 86% suffered blunt injury, and median Injury Severity Score was 13 (IQR 9-25). Overall, 5571 (20%) patients received TXA ≤1 hour from injury, including 368/3,403 (11%) with very low risk, 494/4,764 (10%) low risk, 1,805/9,408 (19%) medium risk, 2,003/8,173 (25%) high risk, and 901/1,524 (59%) very high risk of TIC (χ² for trend: p<0.001). Of those with medium or higher TIC risk, 75% did not receive TXA ≤1 hour.</p><p><strong>Conclusions: </strong>Earlier identification of patients that may benefit from TXA using a machine learning risk prediction model may allow more tailored and prompt treatment for patients at risk of TIC.</p><p><strong>Level of evidence and type of study: </strong>Level III, Retrospective Cohort.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002245"},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607655","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":"Damage control surgery in large-scale combat operations: still a life-saving strategy or a bridge to nowhere?","authors":"Mason Hil Remondelli, Kennedy Nye, Todd Collin, Jonathan Wang, Amy Wang, Rex Atwood, Joseph Bozzay, Woo Do, Ronald Hardin, Eric Elster, Patrick F Walker, Matthew J Bradley","doi":"10.1136/tsaco-2025-001995","DOIUrl":"10.1136/tsaco-2025-001995","url":null,"abstract":"<p><p>Damage Control Surgery (DCS), originally developed to stabilize critically injured trauma patients, was widely adopted during the Global War on Terror, supported by rapid evacuation and advanced medical infrastructure. Future large-scale combat operations will likely severely disrupt this model due to contested airspace and delayed transport. Patients who have undergone DCS may then be stuck without access to definitive care, overwhelming facilities with limited critical care capacity. A more nuanced context-driven approach to surgical decision-making and embracing a strategy of definitive repair for carefully selected patients could potentially help alleviate the expected challenges we will face in future resource-constrained environments.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001995"},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608069","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}