Trauma Surgery & Acute Care Open最新文献

{"title":"Rise of E-bikes and the need to prevent injuries through investments in infrastructure.","authors":"Shannon Frattaroli, Nan Ni, Christian Douglas","doi":"10.1136/tsaco-2026-002448","DOIUrl":"10.1136/tsaco-2026-002448","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002448"},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607645","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":"Evaluation of trauma-related mortality in Peshawar, Pakistan: a study at Khyber Teaching Hospital.","authors":"Rafi Ullah, Laiba Ali, Farooq Ahmad, Lubna Kashif, Asif Khan, Faheem Ullah, Irfan Khan, Adnan Khan, Saeed Ahmad, Asraf Hussain, Adil Rehman, Javed Iqbal","doi":"10.1136/tsaco-2025-001890","DOIUrl":"10.1136/tsaco-2025-001890","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of death and disability in low-income and middle-income countries. In Pakistan, limited reporting and absence of trauma registries restrict understanding of outcomes in Peshawar.</p><p><strong>Objective: </strong>To describe the patterns, severity, and in-hospital mortality of trauma at Khyber Teaching Hospital (KTH), Peshawar, during 5 years.</p><p><strong>Methods: </strong>This retrospective cohort (2018-2022) included all trauma admissions at KTH. Data on demographics, mechanism, Injury Severity Score (ISS), Revised Trauma Score (RTS), and Glasgow Coma Scale (GCS) Score were extracted. Logistic regression identified predictors of in-hospital death; annual trends were analyzed.</p><p><strong>Results: </strong>Among 10 542 patients (mean age 32±19 years; 72% male), blunt trauma comprised 58%, penetrating injuries 23%, and burns 8%. Road traffic accidents (RTAs) caused half of all injuries, followed by falls (16%), and violence (15%). Overall mortality was 9.4% (n=995), decreasing from 10.8% in 2018 to 8.7% in 2022. Fatalities had higher median ISS (25 vs 9; p<0.001) and more severe traumatic brain injury (56% vs 18%; p<0.001). Independent predictors of death were age >60 years (OR 4.3; 95% CI 3.5 to 5.4), ISS >25 (OR 5.6; 4.5-6.9), systolic BP <90 mm Hg (OR 4.9; 3.9-6.2), and GCS Score <8 (OR 6.1; 4.9-7.7). RTS and Trauma and Injury Severity Score showed strong discrimination (Area under the curve (AUC)=0.90).</p><p><strong>Conclusion: </strong>Trauma mainly from RTAs remains a major cause of in-hospital death at KTH despite modest decline. High ISS, hypotension, and low GCS Score were strongest mortality predictors. Strengthened prehospital care, dedicated trauma centers, and a provincial registry are key to reducing preventable deaths in Khyber Pakhtunkhwa.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001890"},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608011","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 vehicular data on trauma outcomes after motor vehicle crashes.","authors":"Sarah D Diaz, Jamila K Picart, Shukri Dualeh, Staci T Aubry, Jonathan W Scott, Stewart C Wang, Mark R Hemmila, Raymond A Jean","doi":"10.1136/tsaco-2025-001881","DOIUrl":"10.1136/tsaco-2025-001881","url":null,"abstract":"<p><strong>Introduction: </strong>Field triage guidelines exist to inform first responder personnel on criteria to expedite the transfer of motor vehicle collision (MVC) patients to trauma centers; however, these guidelines are minimally informed by the vehicle characteristics and collision characteristics. Given this, we studied associations of the vehicle characteristics and collision characteristics with patient injury and outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective study using Michigan State Police crash reports linked with Michigan Trauma Quality Improvement Program collaborative quality initiative data. Univariable analysis was used to identify characteristics predictive of the primary outcome of severe injury, defined as an Injury Severity Score >15 (ISS>15), and multivariable logistic regression analysis was performed across primary and secondary outcomes of ISS>15, mortality, and the need for surgery, intensive care, or transfer to another hospital.</p><p><strong>Results: </strong>There were 13 154 linked cases between the two data sources. This contained 52.3% males with a mean age of 41.7 years (SD 20.7 years). In multivariable logistic regression, the collision characteristics associated with the highest increased odds of ISS>15 were single-vehicle crashes (OR 1.35, p<0.01) and head-on crashes (OR 1.54, p<0.01). Head-on crashes (OR 1.60, p<0.01) and single-vehicle crashes (OR 1.46, p=0.03) were associated with a significantly increased risk of mortality. Head-on crashes (OR 1.49, p<0.01) and single-vehicle crashes (OR 1.37, p<0.01) were associated with the highest odds of operative intervention or intensive care.</p><p><strong>Conclusions: </strong>Several vehicle and collision characteristics are associated with increased odds of severe traumatic injury and death after MVC. The addition of these characteristics to field triage assessments could improve triage decision-making to predict injury severity and the risk of mortality.</p><p><strong>Level of evidence: </strong>III, prognostic, epidemiological.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001881"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473109","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":"Door to needle time: has the 2022 ACS VRC interventional radiology readiness standard made a difference?","authors":"Adrian A Maung, Christofer Anderson, Andrew Tsuei Maung, Tyler Jones, Jane R Cowan, Kimberly A Davis","doi":"10.1136/tsaco-2025-002186","DOIUrl":"10.1136/tsaco-2025-002186","url":null,"abstract":"<p><strong>Objective: </strong>In 2022, the revised American College of Surgeons (ACS) Verification Review and Consultation (VRC) standards required that all level I and II trauma centers have the resources for an interventional radiology procedure for hemorrhage control to begin within 60 min of request. We sought to investigate the impact of this new standard on time to angiography and patient outcomes in a national database with the hypothesis that the ACS standard would result in quicker time to angiography and improved outcomes.</p><p><strong>Methods: </strong>This is a retrospective review of all patients included in the 2019, 2021 and 2023 ACS Trauma Quality Programs Participant Use File who underwent urgent angiography for hemorrhage control in Level I and II trauma centers. We compared times and outcomes pre-implementation and post implementation of this standard.</p><p><strong>Results: </strong>The time to angiography, as measured from emergency department admission, was comparable before and after the implementation of the standard (1.91, 1.86 and 1.91 hours in 2019, 2021 and 2023 respectively, p=0.159). The cohorts also had no significant difference in mortality (15.3, 14.4 vs 14.8%), total length of stay (LOS) (15.6, 15.8 vs 16.1 days) or intensive care unit LOS (8.2, 8.1 vs 8.3 days). There were significant differences with increased blood product transfusion volumes in 2019 (1,386 (2019), 1,228 (2021) and 1,226 mL (2023), p<0.001) as well as increased whole blood use in 2023 (134 (2021) vs 219 mL (2023), p<0.001).</p><p><strong>Conclusion: </strong>Despite the new VRC standard, there has, to date, been no significant impact on time to angiography or patient outcomes with the possible exception of blood transfusion volumes.</p><p><strong>Level of evidence: </strong>IV: retrospective study with more than one negative criterion.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002186"},"PeriodicalIF":2.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413035","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":"Continuing problem of alcohol misuse and amplified health risk behaviors.","authors":"Alice M Ellyson, Frederick Rivara","doi":"10.1136/tsaco-2026-002465","DOIUrl":"10.1136/tsaco-2026-002465","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002465"},"PeriodicalIF":2.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412993","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":"Adopting common data elements for the National Trauma Research Repository through a consensus meeting: the trauma core.","authors":"John David Cull, Pamela J Bixby, Nee-Kofi Mould-Millman, Smith Foster Heavner, Nicolas W Medrano, Olga Volk, Suresh Agarwal, Jennifer M Gurney, Mary J Homer, Avery B Nathens, James Boyce Phillips, Travis Polk, Michelle A Price, Carl I Schulman, Kevin M Schuster, Deborah M Stein, Shelly Timmons, Nathan White","doi":"10.1136/tsaco-2025-002064","DOIUrl":"10.1136/tsaco-2025-002064","url":null,"abstract":"<p><strong>Background: </strong>Trauma remains one of the leading causes of death and disability in the USA, yet trauma research continues to suffer from inconsistent data collection standards, hindering data aggregation and interoperability. To advance trauma science and improve patient outcomes, the Department of Defense, in collaboration with the Coalition for National Trauma Research (CNTR), aimed to identify and implement a core set of common data elements (CDEs) for universal use in trauma research.</p><p><strong>Methods: </strong>A consensus-driven methodology guided by ACCORD reporting standards was employed. CNTR established a CDE Steering Committee comprising military, civilian, and academic trauma experts. Existing trauma and traumatic brain injury CDEs from the National Trauma Research Repository (NTRR) and the Federal Interagency Traumatic Brain Injury Research Informatics System were systematically compared, harmonized, and refined using informatics tools and expert feedback. The CDE Steering Committee met to evaluate 50 candidate data elements, with consensus defined as ≥80% agreement a priori.</p><p><strong>Results: </strong>Nineteen committee members (9 in person, 10 virtually) participated in the survey. A final set of 10 core trauma CDEs was approved for inclusion in NTRR v2, categorized under demographics and injury characteristics. An additional 22 elements were referred to domain-specific workgroups for consideration in future basic CDE development. This process marks a critical step in improving trauma data harmonization.</p><p><strong>Discussion: </strong>The adoption of these core trauma CDEs will support harmonization across trauma studies, enabling data reuse, pooled analysis, and cost-efficient trauma research. While consensus-based, this approach allows flexibility across study types but does not guarantee data harmonization. Successful implementation hinges on endorsement from funders and institutions. Future work includes developing therapeutic area-specific basic CDEs and promoting CDE adoption through training, technical support, and dissemination strategies.</p><p><strong>Level of evidence: </strong>Not applicable (methods-focused study).</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 3","pages":"e002064"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391806","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":"Adopting common data elements (CDEs) for the National Trauma Research Repository (NTRR): the results of an epidemiology Delphi survey.","authors":"Jennifer Margaret Gurney, Nicolas W Medrano, Jeffrey A Bailey, Smith F Heavner, John B Holcomb, Molly P Jarman, Colleen M Ryan, Carl I Schulman, Jonathan Daniel Stallings, David T Harrington, Olga Volk","doi":"10.1136/tsaco-2025-002095","DOIUrl":"10.1136/tsaco-2025-002095","url":null,"abstract":"<p><strong>Introduction: </strong>To support the development of the National Trauma Research Repository (NTRR), a multidisciplinary workgroup used a consensus-driven approach to review established epidemiologic data elements and recommend basic common data elements (CDEs) for inclusion in the NTRR data dictionary.</p><p><strong>Methods: </strong>A 10-member workgroup of military and civilian trauma researchers and data scientists located and reviewed databases, codebooks, data collection forms, and published articles for data elements relevant to trauma epidemiology. Identified data elements were reviewed in a three-round Delphi survey, and monthly meetings with the workgroup were conducted. Consensus during the Delphi survey was analyzed with an 80% agreement threshold.</p><p><strong>Results: </strong>13 sources were reviewed for epidemiology data elements. After the three survey rounds and workgroup discussions, 33 elements (80%) reached consensus for inclusion, 3 elements (7%) were excluded, and 5 elements (12%) did not reach consensus.</p><p><strong>Discussion: </strong>The Delphi process proved effective in achieving expert consensus on basic CDEs for trauma epidemiologic research. The resulting standardized basic CDEs will improve data harmonization and support consistent data collection in the NTRR. These CDEs represent an initial framework and serve as a foundational starting point for epidemiological data collection within the NTRR. As researchers use the NTRR, the list of CDEs will grow and evolve with the needs of the trauma research community. CDE standardization not only supports interoperable research but also enhances research quality, efficiency, and translation into clinical practice.</p><p><strong>Level of evidence: </strong>Level VII.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 3","pages":"e002095"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391690","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":"Early intubation decisions in burn-related inhalation injury: a systematic review of the utility of physical findings in rural and low-resource healthcare settings.","authors":"Aditya Wardhana, Nadya Farhana","doi":"10.1136/tsaco-2025-002208","DOIUrl":"10.1136/tsaco-2025-002208","url":null,"abstract":"<p><strong>Background: </strong>Bronchoscopy is the gold standard for diagnosing inhalation injury in burn patients. However, its availability remains limited even in major cities such as Jakarta. This lack of access presents significant diagnostic challenges, particularly in rural and resource-limited areas across Indonesia. This paper aims to review physical findings for the early diagnosis of inhalation injury in burn patients and to identify indicators for early intubation in settings where bronchoscopy is limited or unavailable.</p><p><strong>Methods: </strong>A literature review was conducted using the keywords \"inhalation injury,\" \"burns,\" and \"intubation,\" with PubMed, Cochrane, and ScienceDirect as the primary databases. The inclusion criteria for this review consisted of trials that evaluated physical findings as diagnostic tools for inhalation injury, with bronchoscopy serving as the gold standard. Study selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with two independent reviewers assessing eligibility. Risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 tool for diagnostic accuracy studies. Pooled sensitivity, specificity, and diagnostic ORs (DORs), along with 95% CIs, were calculated for individual physical findings and clinical decision aids.</p><p><strong>Results: </strong>Ten physical findings for inhalation injury were analyzed and ranked by DORs. Most findings showed high specificity and low sensitivity. The pooled DOR ranged from 0.93 to 7.50. Dyspnea had the highest DOR of 7.50 (95% CI 0.48 to 119.17), while singed nasal hair had the lowest DOR of 0.93 (95% CI 0.09 to 9.71). Dyspnea, stridor, and hoarseness exhibited the highest DOR among other physical findings.</p><p><strong>Conclusion: </strong>Physical examination remains essential where bronchoscopy is unavailable, although most findings have limited sensitivity. Physical signs with the highest diagnostic accuracy, especially dyspnea, stridor, and hoarseness, may help guide early intubation in resource-limited settings.</p><p><strong>Prospero registration number: </strong>CRD420250651230.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002208"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391633","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":"Adopting common data elements (CDEs) for the National Trauma Research Repository (NTRR): the results of a social determinants of health Delphi survey.","authors":"Smith F Heavner, Nicolas W Medrano, Michaela A West, Juan Pablo Herrera-Escobar, Lindsay D Nelson, Karen Lutrick, Terri deRoon-Cassini, Xiaohan Tanner Zhang, Christina Colosimo, Garrett Dennis Hall, Monique Pappadis, Heather X Rhodes-Lyons, Casey Green","doi":"10.1136/tsaco-2025-002148","DOIUrl":"10.1136/tsaco-2025-002148","url":null,"abstract":"<p><strong>Introduction: </strong>To support the development of the National Trauma Research Repository (NTRR), a multidisciplinary workgroup used a consensus-driven approach to review established social determinants of health data elements and recommend trauma common data elements (CDEs) for inclusion in the NTRR data dictionary.</p><p><strong>Methods: </strong>A 13-member workgroup of military and civilian trauma researchers and data scientists located and reviewed databases, codebooks, screening toolkits, and published articles for data elements relevant to social determinants of health. Identified data elements were reviewed in a three-round Delphi survey and monthly meetings with the workgroup were conducted. Consensus during the Delphi survey was identified with an 80% agreement threshold.</p><p><strong>Results: </strong>18 sources were reviewed for data elements relevant to social determinants of health. After the three-round Delphi and post-Delphi workgroup discussions, 29 (42%) data elements, 11 (73%) toolkits, and two (67%) medical terminologies reached consensus for inclusion.</p><p><strong>Discussion: </strong>The resulting standardized CDEs will improve data harmonization and support consistent data collection in the NTRR. These CDEs represent an initial framework and serve as a foundational starting point for social determinants of health data collection within the NTRR. As researchers use the NTRR, the list of CDEs will grow and evolve with the needs of the trauma research community.</p><p><strong>Level of evidence: </strong>Level VII.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 3","pages":"e002148"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391638","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":"Building a unified trauma data repository: bridging military and civilian research to transform care.","authors":"James Boyce Phillips, Pamela J Bixby, Michelle A Price","doi":"10.1136/tsaco-2025-002086","DOIUrl":"10.1136/tsaco-2025-002086","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 3","pages":"e002086"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391814","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}