Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Pediatric trauma over a decade: demographics, mechanisms of injury, and mortality at a major Danish trauma center-a retrospective cohort study.","authors":"Mette Schytt Price, Nikolaj Raaber, Per Hviid Gundtoft, Frederik Trier","doi":"10.1186/s13049-025-01348-9","DOIUrl":"10.1186/s13049-025-01348-9","url":null,"abstract":"<p><strong>Background: </strong>In recent decades, the number of fatal accidents among children and adolescents has declined. Nevertheless, trauma remains a significant cause of death among children and adolescents in high-income countries, despite significant advancements in prevention and care. Pediatric trauma patients differ substantially from adults in terms of their physiology, anatomy, and daily activities; therefore, they show distinct injury patterns and require different care. The aim of this study was to investigate mortality from trauma in pediatric patients admitted by trauma team activation at the Aarhus University Hospital Trauma Center (AUH-TC) in a highly developed country with exceptionally low child mortality, where trauma is a leading cause of death in this age-group. By evaluating trends in demographics, mechanisms of injury, injury severity, and outcomes, this study aims to provide insights into trauma care and outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included 1,037 pediatric patients (< 18 years old) consecutively admitted by trauma team activation from 1 January 2011 to 31 December 2021. The pediatric patients accounted for 14% of the total trauma population, which consisted of 7307 patients in total. Data on demographics, Injury Severity Score (ISS), mechanism of injury, and 30-day mortality were analyzed. Descriptive statistics were reported.</p><p><strong>Results: </strong>Boys accounted for 58% of the patients (n = 595). Falls were the mechanism of injury in 47% (n = 308) of children under 13 years old, while traffic-related injuries accounted for 38% (n = 139) of adolescents aged 14-17 years. Severe injuries (ISS > 15) were associated with traffic accidents in 25% of cases. The number of traumas peaked on weekends (71%) and during the spring/summer (29%). The ISS was greater than 15 in 13% (n = 130) of the patients, and the overall 30-day mortality rate was 1.6% (n = 17).</p><p><strong>Conclusions: </strong>This study found no significant change in pediatric trauma incidence at AUH-TC over a decade. In Denmark, the few children with an ISS above 15 are predominantly injured in traffic accidents, with risk increasing with age. There was a low incidence of patients with an ISS above 15, and mortality rates were lower than in similar studies. These findings on injury patterns and severity may aid in risk assessment, accident prevention, and hospital resource planning. Further research with extended follow-up is recommended to assess potential trends in trauma mechanisms over time.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"39"},"PeriodicalIF":3.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness strategies and the physiological impact of pain in prehospital analgesia management.","authors":"Neslihan Ergun Suzer, Sarper Yilmaz","doi":"10.1186/s13049-025-01343-0","DOIUrl":"10.1186/s13049-025-01343-0","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"38"},"PeriodicalIF":3.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Factors affecting communication time in an emergency medical communication centers.","authors":"Melisande Bensoussan, Mathilde Vannier, Thomas Loeb, Jérémie Boutet, Frédéric Lapostolle, Paul-Georges Reuter","doi":"10.1186/s13049-025-01356-9","DOIUrl":"10.1186/s13049-025-01356-9","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"37"},"PeriodicalIF":3.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of non-invasive ventilation before prehospital emergency anesthesia in trauma - a cohort analysis with machine learning.","authors":"André Luckscheiter, Manfred Thiel, Wolfgang Zink, Johanna Eisenberger, Tim Viergutz, Verena Schneider-Lindner","doi":"10.1186/s13049-025-01350-1","DOIUrl":"10.1186/s13049-025-01350-1","url":null,"abstract":"<p><strong>Background: </strong>For preoxygenation, German guidelines consider non-invasive ventilation (NIV) as a possible method in prehospital trauma care in the absence of aspiration, severe head or face injuries, unconsciousness, or patient non-compliance. As data on the utilization and characteristics of patients receiving NIV are lacking, this study aims to identify predictors of NIV usage in trauma patients using machine learning and compare these findings with the current national guideline.</p><p><strong>Methods: </strong>A cross-regional registry of prehospital emergency services in southwestern Germany was searched for cases of emergency anesthesia in multiply injured patients in the period from 2018 to 2020. Initial vital signs, oxygen saturation, respiratory rate, heart rate, systolic blood pressure, Glasgow Coma Scale (GCS), injury pattern, shock index and age were examined using logistic regression. A decision tree algorithm was then applied in parallel to reduce the number of attributes, which were subsequently tested in several machine learning algorithms to predict the usage of NIV before the induction of anesthesia.</p><p><strong>Results: </strong>Of 992 patients with emergency anesthesia, 333 received NIV (34%). Attributes with a statistically significant influence (p < 0.05) in favour of NIV were bronchial spasm (odds ratio (OR) 119.75), dyspnea/cyanosis (OR 2.28), moderate and severe head injury (both OR 3.37) and the respiratory rate (OR 1.07). Main splitting points in the initial decision tree included auscultation (rhonchus and bronchial spasm), respiratory rate, heart rate, age, oxygen saturation and head injury with moderate head injury being more frequent in the NIV group (23% vs. 12%, p < 0.01). The rates of aspiration and the level of consciousness were equal in both groups (0.01% and median GCS 15, both p > 0.05). The prediction accuracy for NIV usage was high for all algorithms, except for multilayer perceptron and logistic regression. For instance, a Bayes Network yielded an AUC-ROC of 0.96 (95% CI, 0.95-0.96) and PRC-areas of 0.96 [0.96-0.96] for predicting and 0.95 [0.95-0.96] for excluding NIV usage.</p><p><strong>Conclusions: </strong>Machine learning demonstrated an excellent categorizability of the cohort using only a few selected attributes. Injured patients without severe head injury who presented with dyspnea, cyanosis, or bronchial spasm were regularly preoxygenated with NIV, indicating a common prehospital practice. This usage appears to be in accordance with current German clinical guidelines. Further research should focus on other aspects of the decision making like airway anatomy and investigate the impact of preoxygenation with NIV in prehospital trauma care on relevant outcome parameters, as the current evidence level is limited.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"35"},"PeriodicalIF":3.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the properties of the odds ratio to improve precision in meta-analysis: an update on the benefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically ill and injured patients.","authors":"Ryan D McHenry","doi":"10.1186/s13049-025-01345-y","DOIUrl":"10.1186/s13049-025-01345-y","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"36"},"PeriodicalIF":3.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma outcomes differences in females: a prospective analysis of 76 000 trauma patients in the Asia-Pacific region and the contributing factors.","authors":"Mohamad Iqhbal Bin Kunji Mohamad, Sabariah Faizah Jamaluddin, Norhaiza Ahmad, Arifah Bahar, Zarina Mohd Khalid, Nuraina Aqilah Binti Mohd Zaki, Nurul Azlean Norzan, Sang Do Shin, Goh E Shaun, Wen-Chu Chiang, Kentaro Kajino, Kyoung Jun Song, Do Ngoc Son","doi":"10.1186/s13049-025-01342-1","DOIUrl":"10.1186/s13049-025-01342-1","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of mortality, particularly in low and middle-income countries. While extensively studied in North America and Europe, data from the Asia-Pacific are limited. An important area of research is the difference in trauma outcomes, which are theoretically noted to be better among females. However, the clinical findings are inconclusive among Asians. This study examines sex-based differences in trauma outcomes in Asia Pacific, focusing on in-hospital mortality and functional recovery at discharge.</p><p><strong>Methods: </strong>This observational study, from the Pan-Asia Trauma Outcomes Study (PATOS), included 76,645 trauma patients from 12 Asian Pacific countries. We analysed in-hospital mortality and functionality at discharge using the Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS). Logistic regression models were built to test the association of sex on the outcomes.</p><p><strong>Results: </strong>Males exhibited higher in-hospital mortality (1.6%) compared to females (1.06%) ( p < 0.001). Adjusted logistic regression models showed that the female sex is not independently associated with in-hospital mortality. Females have a better functional outcome at discharge for patients younger than 50 years with ISS < 16. However, no significant differences existed between those > 50 years and ISS > 15.</p><p><strong>Conclusion: </strong>This study indicates no difference in the general trauma outcomes in the Asia Pacific between females and males. Although younger females with less severe injuries had better functional outcomes, this advantage disappeared in severe injuries and those over 50 years. These results align with some previous studies, and understanding the nuances may lead to more tailored trauma care, potentially improving patient outcomes.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"34"},"PeriodicalIF":3.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the methodological rigor and overall quality of out-of-hospital clinical practice guidelines: a scoping review.","authors":"Brendan V Schultz, Timothy H Barker, Emma Bosley, Zachary Munn","doi":"10.1186/s13049-025-01344-z","DOIUrl":"10.1186/s13049-025-01344-z","url":null,"abstract":"<p><strong>Objectives: </strong>Out-of-hospital clinical practice guidelines (CPGs) guide paramedics, emergency medical technicians and first responders, but their quality remains uncertain. This scoping review aims to identify, aggregate and describe all literature that has used a structured appraisal instrument to assess the methodological rigor and overall quality of out-of-hospital CPGs.</p><p><strong>Methods: </strong>This study was conducted in accordance with the JBI methodology for scoping reviews and involved systematically searching the following databases and/or information sources with no publication or language limit applied: MEDLINE (Ovid), Embase (Elsevier), CINAHL with full text (EBSCO), Scopus (Elsevier), ProQuest Central (ProQuest).</p><p><strong>Results: </strong>This review identified 15 articles that appraised 311 unique out-of-hospital CPGs. These CPGs ranged in date of publication from 1998 to 2022. The majority of CPGs (267/311) were assessed using the Appraisal of Guidelines for Research & Evaluation (AGREE-II) instrument, with 146 guidelines appraised against two tools. Following aggregation, CPGs scored highest in Domain 4 (clarity of presentation) at 77.7% (SD = 15.1%), and lowest in Domain 5 (applicability) at 42.6% (SD = 23.7%). The average Domain 3 score (rigor of development) was 55.6% (SD = 25.7%). Of CPGs appraised against the AGREE-II instrument, 34.4% met our a priori definition of being high-quality (Domain 3 score of equal to or greater than 75%), while 31.3% were deemed medium-quality (Domain 3 score between 74% and 50%), and 34.3% were considered low-quality (Domain 3 score less than 50%). There were no significant changes observed in the average Domain 3 score over time (p = 0.092). 146 CPGs were assessed against the National Academy of Medicine criteria with 34.9% meeting all elements indicative of being a high-quality guideline, while 39 CPGs were assessed the 2016 National Health and Medical Research Council Standards for Guidelines with 0% meeting all criteria.</p><p><strong>Conclusions: </strong>Out-of-hospital CPGs currently have poor methodological rigor and are of medium to low overall quality. These results should be used to inform future research and initiatives that aim to standardize the methods used to develop guidelines used in this healthcare setting.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"32"},"PeriodicalIF":3.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically ill and injured patients: a systematic review and meta-analysis.","authors":"Adam J Boulton, Terry Brown, Joyce Yeung","doi":"10.1186/s13049-025-01347-w","DOIUrl":"10.1186/s13049-025-01347-w","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"33"},"PeriodicalIF":3.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical interventions, diagnosis, and mortality in children treated by a physician-manned mobile emergency care unit.","authors":"Alexandra Claire McKenzie, Mads Belger Risom, Jens-Jakob Kjer Møller, Johan Mikkelsen, Sarah Friis Skole-Sørensen, Vibe Maria Laden Nielsen, Nicola Groes Clausen, Søren Mikkelsen","doi":"10.1186/s13049-025-01346-x","DOIUrl":"10.1186/s13049-025-01346-x","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to clarify the potentially life-saving critical interventions performed on children below the age of seven by the physician-manned mobile emergency care unit (MECU) in Odense, Denmark. We investigated critical interventions in relation to morbidity and mortality.</p><p><strong>Methods: </strong>A retrospective cohort study of all MECU missions involving children below the age of seven. The study period was from October 1 2007 to December 31 2020. Data sources were the MECU Odense database, the Danish National Patient Registry, and the Danish Civil Registration System. Variables were critical interventions, the severity of injury/illness, MECU on-scene time, in-hospital diagnosis and 7-day, 30-day, and 90-day mortality.</p><p><strong>Results: </strong>The MECU carried out 4,032 missions to children below 7 years. 88 patients (2.2%) received at least one critical prehospital intervention. Upper airway suction was performed in 39 cases (1.0%), endotracheal intubation (all causes) in 36 cases (0.9%), and intraosseous access in 21 cases (0.5%). General anaesthesia was induced in 29 cases (0.7%). Seventeen patients (0.4%) received cardiopulmonary resuscitation and two patients received manual defibrillation (< 0.1%). 3,278 patients were admitted to the hospital and assigned a diagnosis when discharged. The most common diagnoses were assigned within the International Statistical Classification of Diseases and Related Health Problems 10th Revision Chapter XVIII (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified), which includes febrile convulsions. 1,437 patients (43.8%) were assigned diagnoses within this diagnosis group. The overall 7-day mortality in the cohort was 0.74%, 30-day mortality was 0.82%, and 90-day mortality was 1.02%.</p><p><strong>Conclusion: </strong>Prehospital critical interventions are rarely performed in children under the age of 7 years. The low frequency of these interventions may have implications for maintaining the clinical routine of the prehospital care providers.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"30"},"PeriodicalIF":3.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The revised Canadian Bleeding (CAN-BLEED) score for risk stratification of bleeding trauma patients: a mixed retrospective-prospective cohort study.","authors":"Alexandre Tran, Tyler Lamb, Shannon M Fernando, Manya Charette, Marie-Joe Nemnom, Maher Matar, Jacinthe Lampron, Christian Vaillancourt","doi":"10.1186/s13049-025-01336-z","DOIUrl":"10.1186/s13049-025-01336-z","url":null,"abstract":"<p><strong>Background: </strong>Traumatic hemorrhage is a significant cause of morbidity and mortality. There is considerable interest in risk stratification tools to aid with early activation of intervention pathways for bleeding patients. In this study, we refine the Canadian Bleeding (CAN-BLEED) score for the prediction of major interventions in bleeding trauma patients.</p><p><strong>Methods: </strong>We conducted a mixed retrospective-prospective cohort study. We included a retrospective cohort from the CAN-BLEED derivation study, from September 2014 to September 2017. We also conducted a prospective cohort from May 2019 to August 2021 and included both datasets for refinement of the CAN-BLEED score. The primary outcome was major intervention, defined by a composite of massive transfusion, embolization, or surgery for hemostasis. Predictors were pre-specified based on previous validation work. We used a stepdown procedure and regression coefficients to create a clinical risk stratification score. We used bootstrap internal validation to assess optimism-corrected performance.</p><p><strong>Results: </strong>We included 1368 patients in the overall cohort. Incidence of penetrating injury was 23% and median injury severity score was 17. The overall incidence of the need for major intervention was 17%. The revised score included 8 variables: systolic blood pressure, heart rate, lactate, penetrating mechanism, pelvic instability, Focused Abdominal Sonography for Trauma positive for free fluid, computed tomography positive for free fluid, or contrast extravasation. The C-statistic for the simplified score is 0.89. A score cut-off of less than 2 points yielded a 97% (94-98%) sensitivity in ruling out the need for major intervention.</p><p><strong>Conclusion: </strong>The revised CAN-BLEED score offers a clinically intuitive and internally validated tool with excellent performance in identifying patients requiring major intervention for traumatic bleeding. Further efforts are required to evaluate its performance with an external validation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"31"},"PeriodicalIF":3.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}