Trauma Surgery & Acute Care Open最新文献

{"title":"Adopting common data elements (CDEs) for the National Trauma Research Repository (NTRR): the results of an acute hospital Delphi survey.","authors":"Shelly D Timmons, Nicolas W Medrano, Monica Jean Phillips, Carl I Schulman, Smith F Heavner, John David Cull, Daniel Dante Yeh, Valerie G Sams, Maria Cordero Romero, Rondi Beth Gelbard, Samuel Pierce Mandell, John Chovanes, Olga Volk","doi":"10.1136/tsaco-2025-002103","DOIUrl":"10.1136/tsaco-2025-002103","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 acute hospital-based trauma care data elements and recommend common data elements (CDEs) for inclusion in the NTRR data dictionary.</p><p><strong>Methods: </strong>A 14-member workgroup of military and civilian trauma researchers and data scientists located and reviewed databases, codebooks, data collection forms and published articles for trauma data elements relevant to the acute hospital-based trauma care environment. 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 defined by an 80% agreement threshold.</p><p><strong>Results: </strong>31 sources were reviewed for acute hospital-based trauma care data elements. After the three rounds and workgroup discussions, 62 elements (90%) reached consensus for inclusion, 2 elements (3%) were excluded, and 5 elements (7%) did not reach consensus. After final workgroup discussions, 61 elements were recommended for adoption in the NTRR.</p><p><strong>Discussion: </strong>The Delphi process proved effective in achieving expert consensus on data elements for acute hospital-based trauma care research. The resulting standardized CDEs will improve data harmonization and support consistent data collection in trauma research. These CDEs represent an initial framework and serve as a foundational starting point for acute hospital-based trauma care data collection within the NTRR. As researchers use the NTRR, the list of CDEs will grow and evolve to meet the needs of the trauma research community.</p><p><strong>Level of evidence: </strong>VII.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 3","pages":"e002103"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391673","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: the results of a prehospital Delphi survey.","authors":"Nathan James White, Cynthia Lizette Villarreal, Eileen M Bulger, Mirinda Ann Gormley, Jennifer Margaret Gurney, James Hill Homes, Mary J Homer, N Clay Mann, Matthew D Neal, Craig Douglas Newgard, Susan E Rowell, William Arthur Teeter, Olga Volk","doi":"10.1136/tsaco-2025-002135","DOIUrl":"10.1136/tsaco-2025-002135","url":null,"abstract":"<p><strong>Introduction: </strong>To support the development of the National Trauma Research Repository (NTRR), a multidisciplinary workgroup focused on prehospital trauma care used a consensus-driven approach to review established data elements and recommend basic 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, data collection forms, and published articles for data elements relevant to prehospital trauma care. Identified data elements were reviewed in a three-round Delphi survey and during monthly workgroup meetings. Consensus during the Delphi survey was determined with an 80% agreement threshold.</p><p><strong>Results: </strong>Twenty-one sources were reviewed for prehospital data elements. Following three rounds and workgroup discussions, 52 elements (84%) reached consensus for inclusion, two elements (3%) were excluded, and eight elements (13%) did not reach consensus.</p><p><strong>Discussion: </strong>The Delphi process proved effective in achieving expert consensus on basic CDEs for prehospital trauma care 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 prehospital data collection within the NTRR. As researchers use the NTRR, the list of CDEs will grow and evolve to meet the needs of the trauma research community.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 3","pages":"e002135"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391731","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 outcome, outcome measures, and rehabilitation Delphi Survey.","authors":"Kevin M Schuster, Ashley N Moreno, Dagmar Amtmann, Jill Marie Cancio, John Chovanes, Adele Doperalski, Eric Elster, Joseph T Giacino, Kirby Robert Gross, Juan Pablo Herrera-Escobar, Karen J Kowalske, Ingrid Parry, Jeffrey C Schneider, Olga Volk","doi":"10.1136/tsaco-2025-002088","DOIUrl":"10.1136/tsaco-2025-002088","url":null,"abstract":"<p><strong>Introduction: </strong>The National Trauma Research Repository (NTRR) serves as the central warehouse for trauma clinical research data that result from military and civilian trauma research. An effort to enhance the NTRR was undertaken through the identification and integration of common data elements (CDEs). CDEs will improve usability for primary investigators and allow for enhanced secondary analysis and combing of NTRR archived studies. A consensus-driven approach was used to review established data elements and recommend trauma basic CDEs for the outcomes and rehabilitation environments of care for inclusion in the NTRR data dictionary.</p><p><strong>Methods: </strong>A multidisciplinary workgroup located and reviewed data dictionaries, codebooks, data collection forms, and published articles for outcome measurement instruments and individual outcome and rehabilitation data elements. Three rounds of a Delphi Survey were completed, 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>Fifteen sources were reviewed for outcome measurement instruments, 39 measurement instruments were presented for consideration in the Delphi Survey, and 12 instruments (28%) reached consensus for inclusion in the NTRR data dictionary. Seventeen sources were reviewed for individual outcome data elements, 55 data elements were included in the Delphi Survey, and 45 data elements reached consensus for inclusion. Eleven sources were reviewed for rehabilitation data elements. Of the 41 rehabilitation data elements identified and included in the Delphi, 17 data elements reached consensus for inclusion.</p><p><strong>Discussion: </strong>This workgroup selected outcome measurement instruments, outcome CDEs, and rehabilitation CDEs for inclusion in the NTRR data dictionary as basic CDEs. Next steps include disseminating these elements, integrating their use in trauma studies, and tracking the use and usability of these instruments and CDEs.</p><p><strong>Level of evidence: </strong>VII.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 3","pages":"e002088"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391801","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 and emergency departments requires a thoughtful comprehensive innovative response.","authors":"Lenworth Jacobs","doi":"10.1136/tsaco-2026-002473","DOIUrl":"10.1136/tsaco-2026-002473","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002473"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391699","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":"Inguinal hernia patient education series: understanding trauma and emergency surgery conditions.","authors":"Gena Victoria Topper, Tanya Egodage","doi":"10.1136/tsaco-2025-001894","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001894","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001894"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391659","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":"Adjudication instrument for infection in critically injured trauma patients.","authors":"Mary Junak, Haikun Zhang, Hilary Faust, Ambar Haleem, Laura Hammel, Christopher Saddler, Charles Patrick Shahan, Nicole L Werner, Mehreen T Kisat","doi":"10.1136/tsaco-2025-002106","DOIUrl":"10.1136/tsaco-2025-002106","url":null,"abstract":"<p><strong>Background: </strong>Approximately one in four trauma patients admitted to the intensive care unit (ICU) develops an infection, resulting in 20% mortality. In trauma patients, it is difficult to distinguish the systemic inflammation due to injury from infection. Lack of a gold standard for diagnosing infection further complicates recognition and management of sepsis in this population. We developed and piloted an adjudication instrument to analyze infection status in critically injured trauma patients.</p><p><strong>Methods: </strong>Adult trauma patients admitted to the ICU (January-October 2022) were included. Our multidisciplinary adjudication committee of six clinical experts collaboratively developed the case report form (CRF) and infection status form. The CRFs have structured clinical data, and the infection status form includes the likelihood of infection on a Likert scale, site, and type of infection. Two adjudicators were randomly assigned to independently review the CRF and complete the infection status form. If both provided concordant responses, consensus was achieved. If there was a discrepancy in responses, a third adjudicator was assigned to review.</p><p><strong>Results: </strong>40 patients underwent adjudication of infection status. Concordance between the two primary adjudicators was found in 82.5% (33/40). Of these, infection was identified in 18.2% (6/33). In all cases, adjudicators assessed a lung source of bacterial infection. Seven cases were reviewed by a third adjudicator, and infection was identified in 85.7% (6/7).</p><p><strong>Conclusions: </strong>In the absence of a gold standard for the diagnosis of infection in critically injured trauma patients, an adjudication process can be an effective way to standardize the assessment of a study event or endpoint.</p><p><strong>Level of evidence: </strong>Diagnostic tests or criteria; level II.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002106"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391672","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":"Health insurance payor type and care deviations in patients with trauma with lower extremity fractures.","authors":"Elizabeth Swezey, Andrew R Doben, Elisa Szydziak, Anna Jinnah, Misha Chowdhary, Emmanuel Onabolu, Samuel Novick, Naib Chowdhury, Lambros George Angus, Vishes Mehta","doi":"10.1136/tsaco-2025-001939","DOIUrl":"10.1136/tsaco-2025-001939","url":null,"abstract":"<p><strong>Introduction: </strong>Lower extremity fractures result in significant morbidity and mortality, with rehabilitation therapy after injury essential to improving outcomes. Understanding how health insurance coverage may act as a benefit or barrier in accessing postacute services is limited. We sought to determine the association of insurance payor type with access to facility-based rehabilitation after sustaining lower extremity fractures and assess for care deviations between qualified provider recommendations and discharge destination.</p><p><strong>Methods: </strong>A retrospective, cross-sectional study was performed at an American College of Surgeons-verified level 1 trauma center and stratified 2570 patients with lower extremity fractures by health insurance payor type (2016-2022). Care deviation was evaluated as discrepancy of final discharge destination from Physical Therapist and Physical Medicine and Rehabilitation physician recommendations.</p><p><strong>Results: </strong>Traditional and managed Medicare patients were demographically similar and frequently discharged to facility-based rehabilitation (90.5%, 87.7%). Managed Medicare patients were less likely to be discharged to acute rehab (23.6% vs 55.8%) with frequent care deviations from discharge recommendations when compared with traditional Medicare (K=0.40, CI (0.34 to 0.47), K=0.76, CI (0.72 to 0.80)). Medicaid, managed Medicaid, self-pay and privately insured patients were less likely to be discharged to any facility (7.0% to 30.4%), with varying care deviations from discharge recommendations. All payor types were independently predictive of a decreased likelihood of facility-based rehabilitation and higher likelihood of care deviation when compared with traditional Medicare. Managed Medicare was independently predictive of a lower likelihood of discharge to acute rehabilitation (OR 0.46, 95% CI 0.29 to 0.72, p=0.0008).</p><p><strong>Conclusion: </strong>Patients who sustain lower extremity fractures have highest rates of access to postacute services when covered by traditional Medicare. Frequent care deviation from rehabilitation recommendations in commercially administered insurance programs, especially in managed Medicare, highlights the powerful influence of insurance on adherence with clinician-directed care.</p><p><strong>Level of evidence: </strong>This study meets level III evidence criteria.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001939"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391620","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":"Pancreatitis: patient education series - understanding trauma and emergency general surgery conditions.","authors":"Ryan Deci, C Caleb Butts","doi":"10.1136/tsaco-2026-002300","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002300","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002300"},"PeriodicalIF":2.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391674","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":"Advances and uncertainties in fat embolism syndrome: a review.","authors":"Takahito Miyake, Hideshi Okada, Norihide Kanda","doi":"10.1136/tsaco-2025-001913","DOIUrl":"10.1136/tsaco-2025-001913","url":null,"abstract":"<p><p>Fat embolism syndrome (FES) is a complex and potentially life-threatening condition resulting from fat particles entering the circulation, leading to embolic and inflammatory injury across multiple organs, particularly the lungs, brain, and skin. Although the classical triad of respiratory distress, neurological dysfunction, and petechial rash was first described decades ago, clinical presentation remains heterogeneous and often non-specific, complicating timely diagnosis. Existing criteria (Gurd, Wilson, and Lindeque) lack robust validation and remain inadequate in current practice. Imaging modalities, particularly chest CT and brain MRI, alongside emerging biomarkers, such as interleukin-6, might improve diagnostic accuracy, though specificity remains limited. FES management is primarily supportive, focusing on maintaining oxygenation and hemodynamic stability, with invasive ventilation or extracorporeal support required in severe cases. Early fracture stabilization within 24 hours remains the most effective preventive strategy, whereas the use of corticosteroids is controversial owing to inconsistent efficacy and potential adverse effects. In this review, we aim to summarize current understanding of the diagnosis, management, and prevention of FES, while identifying unresolved clinical and research challenges. Relevant literature was identified through PubMed and Scopus searches of English language articles on traumatic and non-traumatic FES published up to 2025. Despite extensive clinical observation, many uncertainties persist regarding the pathophysiology, risk stratification, and optimal treatment of FES. Future directions include refinement of diagnostic criteria through integration of imaging, biomarkers, and artificial intelligence, as well as multicenter studies to establish evidence-based management strategies.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e001913"},"PeriodicalIF":2.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353638","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":"Association of alcohol use with helmet use in cyclists: analysis of the National Trauma Data Bank.","authors":"Daniel C Brock, Gaibo Yan, Chad T Wilson, Emanuel Narcis Husu","doi":"10.1136/tsaco-2025-001974","DOIUrl":"10.1136/tsaco-2025-001974","url":null,"abstract":"<p><strong>Background: </strong>Helmet use significantly reduces the risk of traumatic brain injury among cyclists; however, the influence of alcohol use on helmet-wearing adherence remains understudied in large national data sets. The goal of this study was to investigate the relationship between alcohol use and helmet use in injured cyclists.</p><p><strong>Methods: </strong>This study is a retrospective cross-sectional analysis of 155 766 cyclists with traumatic injuries from the National Trauma Data Bank spanning 8 years (2017-2023). Cyclists were categorized by blood alcohol concentration (BAC) as follows: not screened, sober (BAC <0.02), impaired (BAC 0.02-0.08), intoxicated (BAC ≥0.08), and multidrug intoxicated (BAC ≥0.08 plus ≥1 positive drug screen). The primary outcome was helmet usage. Secondary outcomes included mortality, hospital and intensive care unit length of stay, Injury Severity Score, and adverse events. Comorbid substance use disorders were considered as covariates.</p><p><strong>Results: </strong>Alcohol use was associated with a dose-response decrease in helmet use. Helmet adherence was 45.9% in sober cyclists (n=51 566), compared with 19.9% in impaired (n=1592), 9.8% in intoxicated (n=8327), and 6.2% in multidrug intoxicated cyclists (n=3823; p<0.001). Alcohol use was associated with higher mortality rates (OR=2.3; p<0.001) and a greater proportion of injuries in the head and neck region (OR=1.4; p<0.001). Alcohol use when cycling was significantly associated with comorbid alcohol, tobacco, and substance use disorders (p<0.001). An interaction effect was observed between alcohol use and comorbid alcohol use disorder, where individuals with a history of alcohol use disorder exhibited a lower baseline helmet use that further declined with increasing BAC.</p><p><strong>Conclusions: </strong>Alcohol use demonstrated a significant dose-response relationship with helmet non-usage among cyclists, particularly among those with substance use disorders. This relationship represents a critical public safety concern requiring further investigation to address its public health implications.</p><p><strong>Level of evidence: </strong>Retrospective Epidemiologic/Prognostic study, Level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e001974"},"PeriodicalIF":2.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353591","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}