Trauma-England最新文献

Cost and Inpatient Burden of Orbital Fracture Management: A 14-year Analysis. 眼眶骨折治疗的费用和住院负担：14年的分析。

IF 0.7

Trauma-England Pub Date : 2026-09-02 DOI: 10.1177/14604086261481676

Eli Stein, Rachel E Weitzman, Karena Zhao, Tejas Subramanian, Anthony P Sclafani

{"title":"Cost and Inpatient Burden of Orbital Fracture Management: A 14-year Analysis.","authors":"Eli Stein, Rachel E Weitzman, Karena Zhao, Tejas Subramanian, Anthony P Sclafani","doi":"10.1177/14604086261481676","DOIUrl":"10.1177/14604086261481676","url":null,"abstract":"Introduction: The complexity of orbital fracture management necessitates systematic investigation of the financial burden of these fractures and the cost-effectiveness of management. Here, we analyze the cost and inpatient burden of patients presenting with orbital fractures at an academic medical center.Methods: A retrospective chart review of 1,449 patients presenting with orbital fractures between 2008 to 2022 was performed. Patient characteristics, treatment approach, length of stay (LOS), and hospital costs were collected. Linear regression and pairwise comparison tests were performed to identify factors associated with increased cost burden and LOS.Results: Of the 2,093 total orbital fractures, the most common locations were floor (50%) and medial wall (24%). Average cost of management did not significantly change over time (p=0.072) while average LOS decreased (6.3 to 4 days, p=0.050). Compared to injuries from falls, traffic injuries were associated with higher cost $36,703 vs. $12,513, p<0.001). The presence of ≥4 facial fractures was associated with higher cost ($29,746 vs $6,415, p<0.001), while surgical management was associated with longer LOS (8.3 vs. 3.5 days, p<0.001).Conclusions: The cost or inpatient burden of treating patients with orbital fractures is greater in patients with traffic injuries, ≥4 facial fractures, and operative management.","PeriodicalId":45797,"journal":{"name":"Trauma-England","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13556297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921437","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}

引用次数: 0

Delirium after major trauma critical care and the association with recovery at 12 months. 重大创伤重症监护后谵妄与12个月康复的关系。

IF 0.7

Trauma-England Pub Date : 2025-06-19 eCollection Date: 2025-10-01 DOI: 10.1177/14604086251343660

Robert Christie, Elaine Cole

{"title":"Delirium after major trauma critical care and the association with recovery at 12 months.","authors":"Robert Christie, Elaine Cole","doi":"10.1177/14604086251343660","DOIUrl":"10.1177/14604086251343660","url":null,"abstract":"Purpose: Delirium is associated with poor outcomes in general critical care populations, but the effects on recovery in major trauma patients are less clear. This study aimed to characterise critical care trauma patients with self-reported delirium and explore the relationship with recovery at 12 months post-injury.Methods: A prospective multi-site observational study of patients admitted to four Major Trauma Centre critical care units. Follow-up questionnaires assessed quality of life and recovery using the EQ Visual Analogue Scale (EQ VAS), European Quality-of-Life Five Dimensions (EQ-5D-5L) and the 12-item World Health Organisation Disability Assessment Schedule (WHODAS) 2.0 surveys. Post-discharge support was recorded together with 'difficulties in the 30 days leading up to follow-up' (WHODAS).Results: Of the 285 severely injured adult patients who completed the follow-up questionnaires, 180 (63%) reported delirium in hospital. Traumatic brain injury was higher in the delirium group (40% vs 28%, p = 0.05). Overall health score was worse at 12 months for those reporting delirium (EQ-5D VAS: delirium 67.5 vs no delirium 75, p = 0.01). Patients with delirium also reported more days where difficulties were present (delirium: 22 days vs no delirium: 17 days, p < 0.01) and days of reduced activities (delirium: 7 days vs no delirium: 4 days, p = 0.01). Those with in hospital delirium reported more psychological and cognitive problems via both EQ-5D-5L and WHODAS 2.0. Despite this, fewer than half [n = 79, (44%)] had received any form of psychological support as part of their treatment or recovery.Conclusions: Severely injured trauma critical care patients with self-reported in hospital delirium experience worse quality of life at 12 months post-injury. Psychological problems were greater after in-hospital delirium and longer-term support for these patients appears to be limited.","PeriodicalId":45797,"journal":{"name":"Trauma-England","volume":"27 4","pages":"307-316"},"PeriodicalIF":0.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233730","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}

引用次数: 0

The radiological primary survey: A systematic approach and guide to reading torso computed tomography images in trauma for surgeons 放射学初步调查：外科医生在创伤中阅读躯干计算机断层图像的系统方法和指南

Trauma-England Pub Date : 2024-10-16 DOI: 10.1177/14604086241289240

Joses Dany James, Joseph Chacko Paul, Kirthi Sathyakumar, Vijayan Purushothaman, Vignesh Kumar, Srujan Lam Sharma, Sukria Nayak

{"title":"The radiological primary survey: A systematic approach and guide to reading torso computed tomography images in trauma for surgeons","authors":"Joses Dany James, Joseph Chacko Paul, Kirthi Sathyakumar, Vijayan Purushothaman, Vignesh Kumar, Srujan Lam Sharma, Sukria Nayak","doi":"10.1177/14604086241289240","DOIUrl":"https://doi.org/10.1177/14604086241289240","url":null,"abstract":"Background Trauma is a disease where time is of the essence. In many lower middle-income countries, definitive management and planning for trauma patients are often delayed after working hours because of either a lack of technicians to perform computed tomography (CT) scans or a lack of radiologists to interpret them. These lacunae can be bridged if more and more surgeons become confident in interpreting trauma CT images. Method In this narrative review, written in a ‘how to do it’ manner, we describe a way of doing a structured and quick ‘radiological primary survey’ of the torso CT, which we believe will help quickly identify major injuries systematically, thereby avoiding delays in management and forming a care plan. The method has been developed by a team of trauma surgeons and radiologists and stems from the DRS ABCDE technique used in interpreting trauma chest X-rays. Result The DRS ABCDE extrapolated to the trauma torso CT includes the following steps- Details, WRAP (W-windowing, R-Region, A-Axis, P-Phase), S- the Scout film, Airway, Breathing, Circulation, Disability and Extras. Conclusion The review will enable resident trainees and trauma care professionals to interpret trauma CTs using a structured approach.","PeriodicalId":45797,"journal":{"name":"Trauma-England","volume":"27 1","pages":"3-17"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147887928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Penetrating firearm tracheal injury with cardiac arrest due to tension pneumopericardium 穿透性火器气管损伤并心包张力引起的心脏骤停

Trauma-England Pub Date : 2023-11-09 DOI: 10.1177/14604086231189340

Takshaka Patel, Deirdre Dulak, Lars Ola Sjoholm, Roman Petrov

引用次数: 0

Intact peritoneum in a child with ileal perforation from a firearm injury 儿童因火器伤致回肠穿孔腹膜完整

Trauma-England Pub Date : 2023-11-07 DOI: 10.1177/14604086231205720

Syed Waqas Ali, Yaqoot Jahan, Farah Anwar, Saad Khalid, Muhammad Arif Mateen Khan

{"title":"Intact peritoneum in a child with ileal perforation from a firearm injury","authors":"Syed Waqas Ali, Yaqoot Jahan, Farah Anwar, Saad Khalid, Muhammad Arif Mateen Khan","doi":"10.1177/14604086231205720","DOIUrl":"https://doi.org/10.1177/14604086231205720","url":null,"abstract":"Introduction Indirect intra-abdominal injury with an intact peritoneum following close passage of highly energized projectiles is an uncommon but clearly described phenomenon; likewise delayed gastrointestinal perforation hours or days after passage of a high-energy stress wave from primary blast injury is uncommon. Awareness of these two rare occurrences is required to ensure delayed perforations are diagnosed and managed in a timely manner. Case report An 8-year-old male child sustained a shotgun injury to the right elbow and the abdominal wall only of the right hypochondrium. Due to a non-salvageable joint injury, he underwent amputation of the right upper limb above the elbow, but on the third day of admission, he developed peritonitis and an X-ray revealed pneumoperitoneum. On abdominal exploration, two small ileal perforations were found without penetration of the peritoneum or diaphragm. The ileal injuries were primarily repaired and the postoperative course was uneventful. Conclusion Indirect injury to abdominal viscera from the primary blast effect of close passage of high-energy projectiles resulting is rare and can have significant consequences if not diagnosed and managed early.","PeriodicalId":45797,"journal":{"name":"Trauma-England","volume":"43 177","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135540152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A potential predictor of future firearm-related violence, driving while impaired conviction 这可能预示着未来的枪支暴力，在定罪受损的情况下开车

Trauma-England Pub Date : 2023-10-19 DOI: 10.1177/14604086231208492

Robert D Flint

引用次数: 0

Ballistic injuries of the humerus: A matched cohort analysis 肱骨弹道性损伤:匹配队列分析

Trauma-England Pub Date : 2023-10-09 DOI: 10.1177/14604086231197053

Walter Smith, Samuel Schick, Rodney Arthur, Kyle Paul, Joseph Elphingstone, Srihari Prahad, Kevin Luque-Sanchez, Amit Momaya, Clay Spitler, Eugene Brabston

{"title":"Ballistic injuries of the humerus: A matched cohort analysis","authors":"Walter Smith, Samuel Schick, Rodney Arthur, Kyle Paul, Joseph Elphingstone, Srihari Prahad, Kevin Luque-Sanchez, Amit Momaya, Clay Spitler, Eugene Brabston","doi":"10.1177/14604086231197053","DOIUrl":"https://doi.org/10.1177/14604086231197053","url":null,"abstract":"Introduction Ballistic fractures of the humerus secondary to gunshot wounds are increasingly common injuries that pose challenges for orthopedic surgeons. The primary purpose of this study was to examine the rates of neurovascular injury, compartment syndrome, and infection of ballistic humerus fractures relative to blunt, non-penetrating fractures. Methods A consecutive cohort of 135 patients with ballistic humerus fractures and 167 patients with blunt humerus fractures treated at a level 1 trauma center were identified. A review of patient medical records and radiographic studies was performed to obtain demographic information, injury mechanism, fracture location, choice of treatment, and complications. Statistical analysis was performed using independent sample t-tests, chi-square tests, and odds ratios ( p < 0.05 significance). Results Compared with blunt fractures, patients in the ballistic fracture cohort were younger, male, African American, test positive for illicit drug use, and sustain proximal fractures. Ballistic fractures had significantly lower Injury Severity Scores and New Injury Severity Scores. Ballistic fractures were three times as likely to present with neurovascular injury than blunt fractures (OR: 2.927, p < 0.001). The overall rate of spontaneous recovery of significant motor function for ballistic fractures with neurologic injury was 55%. There were no statistically significant differences in rates of vascular injury, compartment syndrome, infection, non-union, or the need for soft tissue reconstruction. Conclusion Compared with blunt humeral fractures, ballistic fractures appear to have a significantly higher rate of neurologic injury but no increased risk for compartment syndrome or infection. Surgical treatment of ballistic humeral injuries was not associated with increased neurological recovery compared to non-operatively managed fractures.","PeriodicalId":45797,"journal":{"name":"Trauma-England","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Iatrogenic ulnar nerve palsy associated with supracondylar humeral fracture in children: A systemic review on its management 儿童医源性尺神经麻痹伴肱骨髁上骨折:对其处理的系统回顾

Trauma-England Pub Date : 2023-09-27 DOI: 10.1177/14604086231197369

Mohammad Arshad Ikram, Huma Shahzad, Justin Vijay Gnanou

{"title":"Iatrogenic ulnar nerve palsy associated with supracondylar humeral fracture in children: A systemic review on its management","authors":"Mohammad Arshad Ikram, Huma Shahzad, Justin Vijay Gnanou","doi":"10.1177/14604086231197369","DOIUrl":"https://doi.org/10.1177/14604086231197369","url":null,"abstract":"Background Supracondylar humeral fractures (SCHFs) are among the most common pediatric fractures. Closed reduction and percutaneous pinning are considered the established gold standard. Biomechanically, cross-pinning is resilient for any axial rotation, but the medial pin increases the risk of iatrogenic injury to the ulnar nerve. Objective A systematic review was conducted to provide an evidence-based analysis of the literature on the management of iatrogenic ulnar nerve injury caused by the medial pin during closed reduction and percutaneous fixation of displaced SCHF in children. Methods MEDLINE, SCOPUS, and ScienceDirect databases were searched to identify all articles that reported ulnar nerve injury caused by the medial pin during closed reduction and percutaneous fixation of displaced SCHF in children and suggested the management. Reference lists from the articles retrieved were further scrutinized to identify any additional studies of interest. Results One thousand six hundred and six articles on SCHF treated by closed reduction and cross-pinning were identified initially with 25 studies included in the analysis after screening. Four thousand six hundred and seventy-five children sustained SCHF with a median age of 7 years. Of 3036 children treated by closed reduction and cross pinning, 205 (6.75%) were diagnosed with iatrogenic ulnar nerve injury. The management involves observation only, removal of the medial pin, or exploration. The average recovery time in the group treated by removal of wire was statistically shorter than the other two groups. Conclusion The evidence suggests surgical exploration of the ulnar nerve can be delayed for up to 7 months, with most studies favouring observation only. In selected cases, immediate removal of the medial pin should be considered.","PeriodicalId":45797,"journal":{"name":"Trauma-England","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135538831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prospective validation of Bowel Injury Prediction Score for early diagnosis of surgically significant blunt bowel and mesenteric injury 肠损伤预测评分用于外科意义的钝性肠和肠系膜损伤早期诊断的前瞻性验证

Trauma-England Pub Date : 2023-09-26 DOI: 10.1177/14604086231187523

Shubham Kumar Gupta, Pramod Kumar Singh, Sumit Sharma, Sanjeev Kumar Gupta

{"title":"Prospective validation of Bowel Injury Prediction Score for early diagnosis of surgically significant blunt bowel and mesenteric injury","authors":"Shubham Kumar Gupta, Pramod Kumar Singh, Sumit Sharma, Sanjeev Kumar Gupta","doi":"10.1177/14604086231187523","DOIUrl":"https://doi.org/10.1177/14604086231187523","url":null,"abstract":"Background Blunt bowel and mesenteric injuries (BBMI) are frequently missed despite the widespread use of computed tomography (CT). Early diagnosis for timely management of surgically significant blunt bowel and mesenteric injuries (sBBMI) can be challenging. Several tools predictive for sBBMI have been proposed such as the “Bowel Injury Prediction Score” (BIPS) that is based on presence of abdominal tenderness, white blood cell count ≥17,000/mm 3 and CT grade. The utility of this scoring system for early diagnosis of sBBMI has neither been studied in an Indian population nor prospectively validated. Methods A single-centre prospective cohort study was conducted at a Trauma Centre in India. After screening of 1793 patients with blunt trauma abdomen who presented between 1st January 2022 and 31st August 2022 and underwent CT scan, eventually, 80 patients of age >18 years, hemodynamically stable and CT finding suspicious of BBMI were included. BIPS score was calculated. Patients were followed to evaluate the outcome. Results The incidence of sBBMI was 3.06%. Mean age of study patients was 36.2 ± 16.5 years with male predominance (92.5%) and road traffic accidents the commonest mode of injury. Patients with BBMI were more likely to require operative intervention in the presence of abdominal tenderness at presentation (p < 0.01) and CT grade ≥4 (p < 0.01). For patients with WBC counts of ≥17,000/mm 3 , no statistically significant difference was noted in the need for operative intervention. BIPS ≥2 had 94.5% sensitivity, 72% specificity, 88% PPV, and 86% NPV for identifying patients with sBBMI. Conclusion Calculation of BIPS at the time of presentation can avoid unnecessary delays in surgical management and thereby reduce overall morbidity and mortality even in an Indian setup. However, WBC counts > 17,000/mm 3 were not found to be predictive of sBBMI.","PeriodicalId":45797,"journal":{"name":"Trauma-England","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134958507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bilateral lower extremity injuries in pedestrian versus motor vehicle collisions 行人与机动车碰撞的双侧下肢损伤

Trauma-England Pub Date : 2023-09-21 DOI: 10.1177/14604086231201533

David T Marvin, Jesse Seilern und Aspang, Alexander Webb, Jason Shah, Nicholas Cantu, Roberto C Hernandez-Irizarry, Thomas J Moore

{"title":"Bilateral lower extremity injuries in pedestrian versus motor vehicle collisions","authors":"David T Marvin, Jesse Seilern und Aspang, Alexander Webb, Jason Shah, Nicholas Cantu, Roberto C Hernandez-Irizarry, Thomas J Moore","doi":"10.1177/14604086231201533","DOIUrl":"https://doi.org/10.1177/14604086231201533","url":null,"abstract":"Background Lower extremity (LE) injuries following pedestrian versus motor vehicle collision (PMVC) are a common cause of morbidity and mortality in orthopedic trauma. There is currently no evidence illustrating the presentation of orthopedic bilateral LE injuries (BLEI). This study aimed to evaluate the patterns of BLEI on postoperative outcomes and hospital utilization following PMVC. Methods This retrospective cohort analysis included 532 consecutive patients presenting to a single level I trauma center with LE injuries following PMVC from January 1, 2017 to May 31, 2021. Injury location was categorized by extremity region (hip/femur, knee, leg, ankle, midfoot). Outcome measures included 30-day postoperative complications (infection, compartment syndrome, myocardial infarction, pneumonia, pulmonary embolism, sepsis, stroke) and hospital utilization (length of stay, ICU admission, prolonged ventilation [≥48 h], readmission). Mann–Whitney U, chi-square, and logistic regressions were performed calculating odds ratio (OR) with 95% confidence intervals. Results A total of 142 (26.7%) patients sustained BLEI. The most common BLEI complexes (212 total) were bilateral leg (25.0%), hip/femur and leg (17.0%), leg and knee (12.3%), and hip/femur and knee (8.0%). Bilateral and unilateral injuries showed no difference for postoperative complications (11.3% vs. 6.2%; p = 0.062). However, BLEI had higher odds of ICU admission (OR:2.97, CI:1.68–5.26), prolonged ventilation (OR:2.38, CI:1.24–4.59), and patients remained hospitalized 10.87 days longer (p < 0.001). Conclusion Our findings indicate that more than a quarter of PMVCs with LE injuries present with BLEI and require significantly more hospital resources. This is the first study to characterize BLEI in PMVCs, highlighting associated patterns to encourage heightened awareness in trauma evaluation. Level of Evidence: III","PeriodicalId":45797,"journal":{"name":"Trauma-England","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136155668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0